小细胞肺癌/肺神经内分泌肿瘤分期NCCN2017V1

Small Cell Lung Cancer/Lung Neuroendocrine Tumors小细胞肺癌/肺神经内分泌肿瘤山东省肿瘤医院呼吸肿瘤内科张品良

NCCN Guidelines Version 1.2017 Staging  NCCN指南2017第1版分期

Table 1 - Definition of small cell lung cancer consists of two stages:表1-小细胞肺癌两期的界定：

(1) Limited-stage: AJCC (7th edition) Stage I-III (T any, N any, M0) that can be safely treated with definitive radiation doses. Excludes T3-4 due to multiple lung nodules that are too extensive or have tumor/nodal volume that is too large to be encompassed in a tolerable radiation plan. （1）局限期：AJCC（第七版）的I-III期（任何T、任何N、M0），可以安全地给予根治性放射剂量治疗。除外由于多发肺结节太广泛的T3–4或肿瘤/淋巴结体积太大无法包在一个可以耐受的放疗计划中。

(2) Extensive-stage: AJCC (7th edition) Stage IV (T any, N any, M 1a/b), or T3-4 due to multiple lung nodules that are too extensive or have tumor/nodal volume that is too large to be encompassed in a tolerable radiation plan.
（2）广泛期：AJCC（第七版）IV期（任何T、任何N、M1a/b），或由于多个肺结节太广泛的T3-4或肿瘤/淋巴结体积太大无法包在一个可以耐受的放疗计划中。

Table 2 - Definitions of TNM表2-TNM的定义

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 or less 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) (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 T1a.)肿瘤最大径≤3cm，周围被肺或脏层胸膜包绕，支气管镜检查证明没有侵犯超出叶支气管近端（即，不在主支气管）（任何大小的非常见的表浅播散的具有浸润性成分、局限于支气管壁的肿瘤，可向近端延伸至主支气管，也分类为T1a期。）

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

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

T2 Tumor with any of the following features of size or extent:肿瘤大小或范围具有下列任一特征：

* More than 3 cm but 7 cm or less*>3cm但≤7cm

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

* Invades the visceral pleura (PL1 or PL2)*侵犯脏层胸膜（PL1和PL2）

* 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 more than 3 cm but 5 cm or less in greatest dimension 肿瘤最大径>3cm但≤5cm

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

T3 Tumor more than 7 cm or one that directly invades any of the following: parietal pleural (PL3) chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, parietal pericardium; or tumor in the main bronchus (less than 2 cm distal to the carina 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：壁层胸膜（PL3）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但未累及隆突);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< span="">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: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina, separate tumor nodule(s) in a different ipsilateral lobe 任何大小的肿瘤侵犯下列任一结构：纵隔、心脏、大血管、气管、食管、喉返神经、椎体、隆突、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 to ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, and intrapulmonary nodes including involvement by direct extension转移至同侧支气管周围和/或同侧肺门淋巴结，和肺内淋巴结包括直接侵犯

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

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 (Most pleural (and pericardial) effusions with lung cancer are due to tumor. In a few patients, however, multiple cytopathologic examinations of pleura (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 M0.)对侧叶出现散在的肿瘤结节、胸膜结节或恶性胸腔（或心包）积液（大部分肺癌胸腔（以及心包）积液是肿瘤引起的。然而，在少数患者中，胸腔（心包）积液多次细胞病理学检查肿瘤细胞均是阴性，且积液是非血性、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M0。）

M1b Distant metastasis有远处转移

Table 3 - Anatomic Stage/Prognostic Groups表3 - 解剖分期/预后组

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。