食管癌第八版分期解讀

1、食管癌第8版TNM分期解讀空軍軍醫(yī)大學(xué)第二附屬醫(yī)院中醫(yī)科陜西省重點(diǎn)中西醫(yī)結(jié)合腫瘤?？茝堓x2018-04-19Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L1.目1987年開始,國(guó)際抗癌聯(lián)盟( Union for international cancerControl,UcC)與美國(guó)癌癥聯(lián)合會(huì)( American jointCommittee on

2、Cancer,AJCC)聯(lián)合發(fā)布惡性腫瘤TNM分期標(biāo)準(zhǔn),并不定期更新。目前,臨床上采用的最新版食管癌TNM分期標(biāo)準(zhǔn)是2009年第7版。近日食管癌第8版TNM分期的初稿近期布在 Journal of Thoracic Oncology雜志上Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L2.要點(diǎn)食管上皮及食管胃結(jié)合部上皮源性腫瘤第8版分期分別對(duì)臨床、病

3、理及新輔助治療后進(jìn)行分期,不再使用共同的分期系統(tǒng)。對(duì)于病理TNM分期,pT1分為pT1a及pT1b以便對(duì)期腺癌及鱗癌進(jìn)行亞組分析。并介紹全新的區(qū)域淋巴結(jié)圖譜。棄用組織學(xué)表現(xiàn)為未分化型(G4)這一術(shù)語;組織病理細(xì)胞學(xué)類型需要更深層的分析分期為pT2N0M0的鱗癌,腫瘤位置將不作為分期指標(biāo)。食管胃交界的定義將會(huì)進(jìn)行修訂。 ypTNM分期系統(tǒng)不區(qū)分不同組織學(xué)類型,腺癌及鱗癌共用一個(gè)分期系統(tǒng)Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient

4、 Profilo71Copyright 2004-2017Aspose Pty L3.腫瘤分類表1-6對(duì)分類的標(biāo)準(zhǔn)做了定義。解剖學(xué)上的食管癌分類項(xiàng)目包括原發(fā)性腫瘤(T),區(qū)域淋巴節(jié)(N)和遠(yuǎn)處轉(zhuǎn)移(M)(圖1)。pT1重新定義,細(xì)分為pT1a和pT1bValadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L4.圖1第八版TNM分類Tis(HGDT1b3T4a

5、千4bValadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L5.圖1第八版TNM分類T分期分為Ts:高度不典型增生;T1:癌癥侵犯黏膜固有層,粘膜肌層或粘膜下層,并被分為Tla(癌癥侵犯黏膜固有層或粘膜肌層)和T1b(癌侵犯粘膜下層);T2:癌侵犯固有肌層;T3:癌癥侵犯外膜T4:癌侵入局部結(jié)構(gòu)并且被分類為T4a:癌侵入相鄰結(jié)構(gòu)例如胸膜,心包膜,奇靜脈,膈

6、肌或腹膜,T4b:癌侵入主要相鄰結(jié)構(gòu),例如主動(dòng)脈,椎體或氣管。N分類為N0:無區(qū)域淋巴結(jié)轉(zhuǎn)移;N1:涉及12個(gè)區(qū)域淋巴結(jié)轉(zhuǎn)移N2:涉及3-6個(gè)區(qū)域淋巴結(jié)轉(zhuǎn)移;N3:涉及7個(gè)或以上區(qū)域淋巴結(jié)轉(zhuǎn)移。M分類為M0:無遠(yuǎn)處轉(zhuǎn)移;M1:遠(yuǎn)處轉(zhuǎn)移Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L6.表1原發(fā)腫瘤(T)分期T分x:百發(fā)不節(jié)定3:無原發(fā)腫證據(jù)1:侵黏因

7、有層、黏膜肌昱或是下度a:侵犯黏膜有層或膜孔忌T1b:侵犯盂膜下層T2侵食管肌層T3:侵犯食管纖維膜侵食管周囻結(jié)構(gòu)Ta:,侵犯胸膜、心包、奇脈、;溫暖4b:犯其他近結(jié)梳如主動(dòng)孩、推體、氣管Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L7.表2區(qū)域淋巴結(jié)(N)分期N分期Nx:無法評(píng)估N1:12枚區(qū)域淋巴結(jié)轉(zhuǎn)移N2:3-6枚區(qū)域淋巴結(jié)轉(zhuǎn)移N37枚區(qū)域淋

8、巴結(jié)轉(zhuǎn)移Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L8.表3遠(yuǎn)處轉(zhuǎn)移(M)分期0:無近處轉(zhuǎn)移M:有近處轉(zhuǎn)移Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspose Slides for NET 4.0 dient Profilo71Copyright 2004-2017Aspose Pty L9.表4食管鱗癌位置分類,位置定義以腫瘤中心為參考L分類x:無法評(píng)仨上段:頸部食管下至奇靜脈下緣水平口段:奇靜脈弓下緣下至下肺靜泳水平下段:下肺靜球下至胄,包括食管胃交界Valadon onry.ch Asposeslides for NET 4o dient PEvaluation only.Created with Aspos