肺癌TNM分期的新进展

目前临床上广泛使用的肺癌分期法是1997年正式提出的,在过去的10年中对规范肺癌的诊治及临床研究起到了重要的作用,但也渐渐显示出其不足之处。2007年国际肺癌研究联合会（IASLC）通过收集100869例肺癌患者的临床资料,就TNM分期与预后之间的相关性做了深入分析,提出了对第7版肺癌TNM分期的修改建议：（1）根据肿瘤大小不同,将原来的T分期分为T1a（肿瘤最大直径≤2cm）、T1b（3cm≥肿瘤最大直径〉2cm）、T2a（5cm≥肿瘤最大直径〉3cm）、T2b（7cm≥肿瘤最大直径〉5cm）;（2）将T2c（肿瘤最大直径〉7cm）和原发肺叶内出现转移灶归为T3,将同侧其他肺叶内出现转移灶归为T4;（3）把癌性胸水、心包积液及对侧肺结节转移归为M1a,肺外转移归为M1b。新的版本在国际上将具有更高的权威性和认同度,在今后肺癌的治疗及判断预后上将起到更细致、更精确的指导作用;同时,也为肺癌的研究提供了一个新的起点。

New Progress in TNM Staging of Lung Cancer

The TNM staging of lung cancer which is now widely used in clinic was formally proposed in 1997. It has played quite an important role in directing the diagnosis and treatment of lung cancer as well as the clinical research in the past decade. However,at the same time,there are some insufficiencies which are emerging gradually. By collecting the clinical information from 100 869 patients,in 2007,International Association for the Study of Lung Cancer（IASLC） made a deep analysis on the relativity between TNM staging and prognosis,and put forward the suggestions to revise the Seventh Edition of the TNM staging of lung cancer：（1） According to the size of tumor,the primary T staging is divide into T1a （the maximum tumor diameter≤2 cm）,T1b （3 cm≥the maximum tumor diameter〉2 cm）,T2a （5 cm≥the maximum tumor diameter〉3 cm） and T2b （7 cm≥the maximum tumor diameter〉5 cm）; （2） T2c （the maximum tumor diameter 〉7 cm） and additional nodules in the same lobe are classified as T3,while nodules in the ipsilateral non-primary lobe are classified as T4;（3） Cancerous hydrothorax,pericardial effusion and the additional nodules in the contralateral lung are classified as M1a,while the extrapulmonary metastases are classified as M1b. It is believed that the new revised edition will has higher international authority and identification degree,and it will play a more meticulous and accurate guiding role in the treatment of lung cancer and its predicting prognosis in the future. At the same time,it will provide a new starting point to the research of lung cancer.