对肾细胞癌临床分期的新设想

肾细胞癌简称肾癌,是泌尿外科领域最常见的恶性肿瘤之一。其发病率占泌尿系肿瘤之第二位。肾癌准确的分期直接关系到对其制定正确合理的治疗方案和判断患者的预后,因此极为重要。1968后,Robson在Flocks和Kadseky分类基础上提出了肾癌四期分期法;2002年AJCC(美国癌症联合委员会)的TNM分期法得到国内外广泛的临床应用。但随着临床研究的进展出现了新的观点,到2009年,AJCC对肾癌TNM分期又提出了4点修改意见。可见,随着科学的发展,临床研究的深入,对肾癌的诊治和分期必然会出现一些新观点、新动向,应及时增添进肾癌的分期之中。鉴于上述,我们试图提出一个更简明扼要、易于临床操作、实用性强的新方案,供同道们探讨,起抛砖引玉之效应。我们的方案主要强调先将肾癌的临床表现划为三大类型,即局限型肾癌、局部进展型(或称局部浸润转移型)肾癌和转移型肾癌。然后在每一大类型中再依据肿瘤体积、浸润、转移的不同分为4个期(A期、B期、C期、D期)。本文新分期法简单明了,一目了然,易操作,实用性强。

New conception on clinical staging of renal cell carcinoma

Renal cell carcinoma(renal cancer) is second most common urinary malignancy.Accurate staging of renal cell carcinoma is directly related to formulation of correct treatment scheme and prediction of clinical prognosis.Based on classification by Flocks and Kadseky,staging system of four stage by Robson was put forward from 1968 while TNM staging system by American AJCC in 2002 was applied widely over the world.In 2009,4 piece of Amendments were made by AJCC since new opinion appear with the improvement of clinical research.So new conception and trend will appear definitely which should be added into staging of renal cell carcinoma in time with development of science and clinical research.In view of situation above,we try to put forward a new simple and applicable staging system for further discussion in order to get useful and constructive feed back.In this system we emphasize that renal cell carcinoma is firstly classified into three main types(local,local advanced and metastatic renal cancer) based on clinical manifestation and then is further classified into 4 stages(stage A,B,C and D) according to tumor size,invasion and metastasis in each main type.This new staging system reveal a simple,easy to master,and practicable system.