~Teachingcenter的醫學筆記~

肺癌分期 AJCC 8^th

對於肺癌腫瘤本身的分類
Definition of primary tumor (T)

= Tx
--- 原發腫瘤無法被直接評估(無法直接證實惡性)，或是痰液、支氣管沖洗液中有惡性細胞，但影像或支氣管鏡檢中沒有發現明顯的腫瘤
--- 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
= T0
--- 沒有任何肺癌的證據
--- No evidence of primary tumor
= Tis
--- 原位癌，其中包含鱗狀細胞原位癌、腺原位癌，腺癌限最大徑小於3公分，且為伏壁型表現(lepidic pattern)
--- Carcinoma in situ [Squamous cell carcinoma in situ (SCIS) Adenocarcinoma in situ (AIS): adenocarcinoma with pure lepidic pattern, ≤3 cm in greatest dimension]
= T1
--- 最大徑小於3公分，由臟層肋膜包裹，沒有侵犯肺葉支氣管
--- 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)
= T1mi
--- 微侵潤腺癌，最大徑小於3公分，腫瘤中主要以伏壁型表現，且侵襲深度最深小於5公厘
--- Minimally invasive adenocarcinoma：adenocarcinoma (≤3 cm in greatest dimension), with a predominantly lepidic pattern and ≤5 mm invasion in greatest dimension
= T1a
--- 最大徑小於1公分，表淺地侵犯侷限在支氣管壁
--- Tumor ≤1 cm in greatest dimension. A superficial, spreading tumor of any size whose invasive component is limited to the bronchial wall and may extend proximal to the main bronchus also is classified as T1a, but these tumors are uncommon
--- 1~2公分為T1b，2~3公分為T1c
= T2
--- 腫瘤3~5公分或小於3公分腫瘤有以下任一種情形
--- Tumor >3 cm but ≤5 cm or having any of the following features:
•侵犯到主支氣管但尚未到氣管交接處(Involves the main bronchus regardless of distance to the carina, but without involvement of the carina)
•侵犯到臟層肋膜，不論是彈性層或表層(Invades visceral pleura (elastic layer (PL1) or surface (PL2)))
•合併延續到肺門的肺塌陷或阻塞性肺炎腫 (Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, involving part or all of the lung
--- 3~4公分為T2a，4~5公分為T2b
= T3
--- 腫瘤最大徑5~7公，或腫瘤直接侵犯以下組織或以下表現
--- Tumor >5 cm but ≤7 cm in greatest dimension or directly invading any of the following:
•壁層肋膜(parietal pleura (PL3))、胸壁(chest wall (including superior sulcus tumors))、橫膈神經(phrenic nerve)、壁層心包膜(parietal pericardium)
•同一肺葉中多顆腫瘤(separate tumor nodule(s) in the same lobe as the primary)
= T4
--- 腫瘤大於7公分，或直接侵犯以下組織或以下表現
--- Tumor >7 cm or tumor of any size invading one or more of the following:
•橫膈膜(diaphragm)、中縱膈(mediastinum)、心臟(heart)、大血管(great vessels)、氣管(trachea)、喉返神經(recurrent laryngeal nerve)、食道(esophagus)、脊椎(vertebral body)、氣管交叉處(carina)
•多顆腫瘤位於同側不同的肺葉中(separate tumor nodule(s) in an ipsilateral lobe different from that of the primary)

對於淋巴結的分類
Definition of lymph node (N)
= Nx
--- 無法評估
--- Regional lymph nodes cannot be assessed
= N0
--- 沒有區域性淋巴結轉移
--- No regional lymph node metastasis
= N1
--- 影響到的淋巴結位於同側的支氣管旁、肺內、肺門
--- Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
= N2
--- 影響到同側的縱膈內或支氣管交接處下方的淋巴結
--- Metastasis in ipsilateral mediastinal and/or subcarinal lymph nodes
= N3
--- 影響到的淋巴結位於對側縱膈腔、對側肺門、同側斜角肌或同側鎖骨上區域
--- Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

對於遠端轉移的分類
Definition of distant metastasis (M)
= M0
--- 沒有遠端轉移
--- No distant metastasis
= M1a
--- 腫瘤位於不同側的肺臟(Separate tumor nodule(s) in a contralateral lobe)
--- 腫瘤於肋膜或心包膜播種，或出現惡性肋膜或心包膜積水(Tumor with pleural or pericardial nodules or malignant pleural or pericardial effusion)
= M1b
--- 單一顆胸腔外器官的轉移(包含非區域性淋巴結單一顆的轉移)
--- Single extrathoracic metastasis in a single organ (including involvement of a single nonregional node)
= M1c
--- 多顆胸腔外器官的轉移，可以是單一器官或多器官
--- Multiple extrathoracic metastases in a single organ or in multiple organs

肺癌分期表格