非小细胞肺癌分期NCCN指南2016v4

Non-Small Cell Lung Cancer非小细胞肺癌

NCCN Guidelines Version 4.2016 NCCN指南2016第4版山东省肿瘤医院呼吸肿瘤内科张品良

Staging分期

Table 1. Definitions for T, N, M表1.T、N、M的定义

Used with permission. 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 tumors. J Thorac Oncol 2007;2:706-714.
使用许可。Goldstraw P, Crowley J, Chansky K，等。IASLC肺癌分期项目：在即将到来的恶性肿瘤TNM分类（第七）版TNM分期分组的修订建议。《胸部肿瘤学杂志》2007；2:706-714。

T Primary Tumor 原发肿瘤

TX Primary tumor cannot be assessed, or tumor proven by the presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy原发肿瘤不能评估，或痰、支气管冲洗液中找到恶性细胞但未经影像或支气管镜检查证实

T0 No evidence of primary tumor无原发肿瘤的证据

Tis Carcinoma in situ原位癌

T1 Tumor ≤3 cm in greatest dimension, surrounded by lung or visceral pleura, without bronchoscopic evidence of invasion more proximal than the lobar bronchus (i.e., not in the main bronchus)a 肿瘤最大径≤3cm，被肺或脏层胸膜包绕，无累及叶支气管近端的支气管镜证据（即，不在主支气管）a

T1a Tumor ≤2 cm in greatest dimension肿瘤最大径≤2cm

T1b Tumor >2 cm but ≤3 cm in greatest dimension肿瘤最大径>2cm但≤3cm

T2 Tumor >3 cm but ≤7 cm or tumor with any of the following features: b肿瘤＞3cm但≤7cm或具有以下任意一项：b

Involves main bronchus, ≥2 cm distal to the carina 累及主支气管，距隆突≥2cm

Invades visceral pleura累及脏层胸膜

Associated with atelectasis or obstructive pneumonitis that extends to the hilar region but does not involve the entire lung合并肺不张或阻塞性肺炎，延伸到肺门但未累及全肺

T2a Tumor >3 cm but ≤5 cm in greatest dimension肿瘤最大径＞3cm但≤5cm

T2b Tumor >5 cm but ≤7 cm in greatest dimension肿瘤最大径>5cm但≤7cm

T3 Tumor >7 cm or one that directly invades any of the following: chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus<2 cm distal to the carina a but without involvement of the carina; or associated atelectasis or obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe肿瘤>7cm或直接侵犯下列任何结构之一：胸壁（包括肺上沟瘤）、膈肌、膈神经、纵隔胸膜、心包壁层；或肿瘤位于主支气管距隆突＜2cm，但未及隆突；或伴有累及全肺的肺不张或阻塞性肺炎或在同一叶内单个或多个分散的瘤结节

T4 Tumor of any size that invades any of the following:任何大小的肿瘤侵犯下列任一结构：

mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina;纵隔、心脏、大血管、气管、喉返神经、食管、椎体、隆突；

separate tumor nodule(s) in a different ipsilateral lobe不同叶散的单发或多发的瘤结节

N Regional Lymph Nodes区域淋巴结

NX Regional lymph nodes cannot be assessed区域淋巴结不能评估

N0 No regional lymph node metastasis无区域淋巴结转移

N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension同侧支气管周围和/或同侧肺门淋巴结和肺内淋巴结转移，包括直接侵犯累及

N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)转移至同侧纵隔和/或隆突下淋巴结

N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)转移至对侧纵隔、对侧肺门、同侧或对侧斜角肌或锁骨上淋巴结

M Distant Metastasis远处转移

MX Distant metastasis cannot be assessed远处转移无法评估

M0 No distant metastasis无远处转移

M1 Distant metastasis有远处转移

M1a Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodules or malignant pleural (or pericardial) effusion c 对侧叶散在或多发的瘤结节；肿瘤合并胸膜结节或恶性胸腔（或心包）积液c

M1b Distant metastasis有远处转移

a The uncommon superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend proximally to the main bronchus, is also classified as T1. 任何大小的非常见的表浅播散的肿瘤，只要其浸润成分局限于支气管壁，即使临近主支气管，也定义为T1；

b T2 tumors with these features are classified T2a if ≤5 cm or if size cannot be determined, and T2b if >5 cm but ≤7 cm. 如果肿瘤≤5cm或不能确定大小具有这些特征的T2肿瘤分为T2a，而如果>5cm但≤7cm则分为T2b。

c Most pleural (and pericardial) effusions with lung cancer are due to tumor. In a few patients, however, multiple cytopathologic examinations of pleural (pericardial) fluid are negative for tumor, and the fluid is nonbloody and is not an exudate. Where these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be classified as T1, T2, T3, or T4.
c大多数肺癌患者的胸腔（和心包）积液是由肿瘤引起。然而，在少数患者中，胸腔（和心包）积液多次肿瘤细胞病理检查为阴性，且积液为非血性液、亦非渗出液。综合考虑这些因素及临床判断确定积液与肿瘤无关时，积液应不作为分期因素，患者应分为T1、T2、T3、T4。

Table 2. Anatomic Stage and Prognostic Groups
表2.解剖学分期和预后组

Occult Carcinoma

TX

N0

M0

Stage 0

Tis

N0

M0

Stage IA

T1a

N0

M0

T1b

N0

M0

Stage IB

T2a

N0

M0

Stage IIA

T2b

N0

M0

T1a

N1

M0

T1b

N1

M0

T2a

N1

M0

Stage IIB

T2b

N1

M0

T3

N0

M0

Stage IIIA

T1a

N2

M0

T1b

N2

M0

T2a

N2

M0

T2b

N2

M0

T3

N1

M0

T3

N2

M0

T4

N0

M0

T4

N1

M0

Stage IIIB

T1a

N3

M0

T1b

N3

M0

T2a

N3

M0

T2b

N3

M0

T3

N3

M0

T4

N2

M0

T4

N3

M0

Stage IV

Any T

Any N

M1a

Any T

Any N

M1b

隐匿癌

TX

N0

M0

0期

Tis

N0

M0

ⅠA期

T1a

N0

M0

T1b

N0

M0

IB期

T2a

N0

M0

IIA期

T2b

N0

M0

T1a

N1

M0

T1b

N1

M0

T2a

N1

M0

IIB期

T2b

N1

M0

T3

N0

M0

IIIA期

T1a

N2

M0

T1b

N2

M0

T2a

N2

M0

T2b

N2

M0

T3

N1

M0

T3

N2

M0

T4

N0

M0

T4

N1

M0

IIIB期

T1a

N3

M0

T1b

N3

M0

T2a

N3

M0

T2b

N3

M0

T3

N3

M0

T4

N2

M0

T4

N3

M0

Ⅳ期

任何T

任何N

M1a

任何T

任何N

M1b

Used with the permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original and primary source for this information is the AJCC Cancer Staging Manual, Seventh Edition (2010) published by Springer Science + Business Media, LLC (SBM). (For complete information and data supporting the staging tables, visit www.springer.com.) Any citation or quotation of this material must be credited to the AJCC as its primary source. The inclusion of this information herein does not authorize any reuse or further distribution without the expressed, written permission of Springer SBM, on behalf of the AJCC.经芝加哥伊利诺斯州美国癌症联合委员会(AJCC)许可使用。该信息的原始及主要信源是施普林格科学+商业媒体有限责任公司(SBM)出版的AJCC癌症分期手册第七版(2010)。（关于分期表完整的资料与信息支持，访问www.springer.com.）此材料的任何引用或引文均必须以AJCC作为其主要信源。此资料内容未经施普林格科学+商业媒体代表AJCC书面明示许可不准任何再使用或发行。

Table 3. Descriptors, T and M Categories, and Stage Grouping
表3.描述，T和M分类以及分期组

Used with permission. 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 tumors. J Thorac Oncol 2007;2:706-714.使用许可。Goldstraw P, Crowley J, Chansky K，等。IASLC肺癌分期项目：在即将到来的恶性肿瘤TNM分类（第七）版TNM分期分组的修订建议。《胸部肿瘤学杂志》2007；2:706-714。

6th Edition

7th Edition

T/M Descriptor

T/M

N0

N1

N2

N3

T1 (≤2 cm)

T1a

IA

IIA

IIIA

IIIB

T1 (<2–3 cm)

T1b

IA

IIA

IIIA

IIIB

T2 (≤5 cm)

T2a

IB

IIA

IIIA

IIIB

T2 (<5–7 cm)

T2b

IIA

IIB

IIIA

IIIB

T2 (>7 cm)

T3

IIB

IIIA

IIIA

IIIB

T3 invasion

IIB

IIIA

IIIA

IIIB

T4 (same lobe   nodules)

IIB

IIIA

IIIA

IIIB

T4 extension

T4

IIIA

IIIA

IIIB

IIIB

M1 (ipsilateral   lung)

IIIA

IIIA

IIIB

IIIB

T4 (pleural effusion)

M1a

IV

IV

IV

IV

M1   (contralateral lung)

IV

IV

IV

IV

M1 (distant)

M1b

IV

IV

IV

IV

第六版

第七版

T/M描述

T/M

N0

N1

N2

N3

T1（≤2cm）

T1a

IA

IIA

IIIA

IIIB

T1（＜2–3cm）

T1b

IA

IIA

IIIA

IIIB

T2（≤5cm）

T2a

IB

IIA

IIIA

IIIB

T2（＜5–7cm）

T2b

IIA

IIB

IIIA

IIIB

T2（＞7cm）

T3

IIB

IIIA

IIIA

IIIB

T3浸润

IIB

IIIA

IIIA

IIIB

T4（同叶结节）

IIB

IIIA

IIIA

IIIB

T4范围

T4

IIIA

IIIA

IIIB

IIIB

M1（同侧肺）

IIIA

IIIA

IIIB

IIIB

T4（胸腔积液）

M1a

IV

IV

IV

IV

M1（对侧肺）

IV

IV

IV

IV

M1（远处）

M1b

IV

IV

IV

IV

Cells in bold indicate a change from the sixth edition for a particular TNM category.黑体单元格表示特定TNM分类从第六版的变化。