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肺癌的相关知识(二):肺癌TNM分期系统

肺癌的相关知识(二):肺癌TNM分期系统

引言

肺癌(NSCLC)TNM分期系统是国际公认的用于描述病变范围的系统。TNM系统将肿瘤特征与疾病分期联系起来,疾病分期与生存情况和治疗推荐相关联。TNM分期的目的是提供可便于沟通的癌症解剖范围描述,协助制定治疗决策,并作为预后指标。TNM分期可用于对病例进行比较,特别是对不同治疗方案结局的比较。在临床实践中,TNM分期与患者的独特临床特征相结合,并且在某些情况下,TNM分期结合了肿瘤本身的分子学特征,可指导预后评估和治疗选择。

区别NSCLCSCLC的基本原理

由于临床特征、治疗方法和临床结局的差异,肺癌被细分为两个主要类别,即非小细胞肺癌(non-small cell lung cancer, NSCLC)和小细胞肺癌(small cell lung carcinoma, SCLC)。一般来说,SCLC的生长速度更快,更常位于中央和纵隔,更早出现胸腔外转移,总生存时间更短。小细胞癌通常使用简化的系统进行分期和治疗,分为临床局限期或临床广泛期疾病。

肺癌TNM分期系统简介

TNM分期系统是根据原发肿瘤特点(T)、区域淋巴结受累存在与否(N)、以及远处转移的存在与否(M)对肿瘤进行分类。TNM系统不包括肺癌的分子学肿瘤特征。肿瘤的总体综合分期(Ⅰ)TNM等级组合所决定。如果在任何一项特征中肿瘤的范围不能进行评估,那么在此特征后附加后缀“X”(例如,TXNXMX)。临床-诊断分期、手术-病理分期、复治分期和尸检分期所用的TNM分期系统相同。

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本文主要参考UpToDate临床顾问《肺癌TNM分期系统》一文,包括的参考文献如下:

1. Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11:39.

2. American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 8th ed, Amin MB, Edge SB, Greene FL et al (Eds), Springer, Chicago 2017.

3. Detterbeck FC, Chansky K, Groome P, et al. The IASLC Lung Cancer Staging Project: Methodology and Validation Used in the Development of Proposals for Revision of the Stage Classification of NSCLC in the Forthcoming (Eighth) Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1433.

4. Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The Eighth Edition Lung Cancer Stage Classification. Chest 2017; 151:193.

5. Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2:706.

6. Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 10:990.

7. Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 10:1675.

8. Rusch VW, Asamura H, Watanabe H, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 2009; 4:568.

9. Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2015; 10:1515.