口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读

美国癌症联合委员会《AJCC肿瘤分期手册》与美国国立综合癌症网(NCCN）肿瘤学临床实践指南已广泛用于临床实践中。NCCN肿瘤诊治指南与TNM分期密切相关,指南为不同TNM分期的肿瘤制定了较为详细的诊治标准,作为依据指导临床应用。2017年第8版口腔及口咽癌TNM分期新增了较多内容,如侵袭深度（DOI）、淋巴结外扩展（ENE）、人乳头瘤病毒（HPV）等指标用于了新的分期中,并且为HPV相关的口咽癌制定了一个新的TNM分期。2018年版NCCN口腔与口咽癌指南及时反映了第8版口腔及口咽癌TNM分期中新的变化,同时亦为HPV相关的口咽癌制定了相应的诊治指南。新的TNM分期及NCCN诊治指南对口腔与口咽癌患者诊疗策略的制定及治疗方案的选择具有较大的指导意义。为了临床工作的需要,本文结合两者的变化进行了部分解读。

Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx

The AJCC Cancer Staging Manual and the NCCN Clinical Practice Guidelines in Oncology are widely used in clinical practice. NCCN diagnosis and treatment guidelines are closely related to TNM staging, and the guidelines provide more detailed diagnostic and therapeutic criteria for cancers with different TNM staging as a basis for guiding clinical application. The 8th edition TNM staging system for cancers of the oral cavity and oropharynx introduced a number of significant changes, such as depth of invasion(DOI), extranodal extension (ENE), human papillomavirus(HPV) and other indicators were used in the new stage, and a new chapter describing the staging of HPV-associated oropharyngeal cancers had been added. The 2018 NCCN guidelines for cancers of the oral cavity and oropharynx timely reflected the new changes in the 8th edition TNM staging, and the panel also created separate algorithms for HPV-associated (p16-positive) oropharyngeal cancer. The new TNM staging and NCCN guidelines are of great guiding significance in the treatment strategies and plans for patients with cancers of the oral cavity and oropharynx. The treatment recommendations were provided and the interpretation was made for the needs of clinical practice in this paper.