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严佶祺 三甲
严佶祺 主任医师
上海瑞金医院 普外科

甲状腺癌的TNM分期

    肿瘤的分期往往是依据肿瘤本身的大小(T),有无区域淋巴结转移(N),以及有无远处转移(M),来划分肿瘤的进展程度,也就是通常所说的TNM分期。对普通患者来说,最近一版(2010年)的甲状腺癌TNM分期依然错综复杂。然而,我们从中不难看出,年轻患者 (<45岁)只要是分化型甲状腺癌,也就是最为常见的乳头状癌和滤泡性癌,无论肿块大小以及淋巴结有无转移,全部归于第 I期。由此可见,我们只要心态平和,积极治疗,甲状腺癌的预后会是令人鼓舞的。上海交通大学医学院附属瑞金医院普外科严佶祺

 

Table 1: Primary Tumor (T)

 

TX

Primary tumor cannot be assessed.

T0

No evidence of primary tumor.

T1

Tumor ≤2 cm in greatest dimension limited to the thyroid.

T1a

Tumor ≤1 cm, limited to the thyroid.

T1b

Tumor >1 cm but ≤2 cm in greatest dimension, limited to the thyroid.

T2

Tumor >2 cm but ≤4 cm in greatest dimension, limited to the thyroid.

T3

Tumor >4 cm in greatest dimension limited to the thyroid or any tumor with minimal extrathyroid extension (e.g., extension to sternothyroid muscle or perithyroid soft tissues).

T4a

Moderately advanced disease.

 

Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus, or recurrent laryngeal nerve.

T4b

Very advanced disease.

T4a

Intrathyroidal anaplastic carcinoma. 

T4b

Anaplastic carcinoma with gross extrathyroid extension.

 

 

Table 2: Regional Lymph Nodes (N)

 

NX

Regional lymph nodes cannot be assessed.

N0

No regional lymph node metastasis.

N1

Regional lymph node metastasis.

N1a

Metastases to Level VI (pretracheal, paratracheal, and prelaryngeal/Delphian lymph nodes).  中央组淋巴结转移

N1b

Metastases to unilateral, bilateral, or contralateral cervical (Levels I, II, III, IV, or V) or retropharyngeal or superior mediastinal lymph nodes (Level VII).  非中央组淋巴结转移

 

 

Table 3: Distant Metastasis (M)

 

M0

No distant metastasis.

M1

Distant metastasis

 

 

Table 4:  Anatomic Stage/Prognostic Groups

 

Stage 

T 

N 

M 

Papillary or follicular (differentiated)  乳头状癌或滤泡性癌

YOUNGER THAN 45 YEARS  年龄小于45岁

I

Any T

Any N

M0

II

Any T

Any N

M1

45 YEARS AND OLDER  年龄大于45岁

I

T1

N0

M0

II

T2

N0

M0

III

T3

N0

M0

 

T1

N1a

M0

 

T2

N1a

M0

 

T3

N1a

M0

IVA

T4a

N0

M0

 

T4a

N1a

M0

 

T1

N1b

M0

 

T2

N1b

M0

 

T3

N1b

M0

 

T4a

N1b

M0

IVB

T4b

Any N

M0

Stage IVC

Any T

Any N

M1

 

 

 

Stage 

T 

N 

M 

Medullary carcinoma (all age groups)  髓样癌(所有年龄)

I

T1

N0

M0

II

T2

N0

M0

 

T3

N0

M0

III

T1

N1a

M0

 

T1

N1a

M0

 

T2

N1a

M0

 

T3

N1a

M0

IVA

T4a

N0

M0

 

T4a

N1a

M0

 

T1

N1b

M0

 

T2

N1b

M0

 

T3

N1b

M0

 

T4a

N1b

M0

 

Stage IVB

T4b

Any N

IVB

T4b

Any N

M0

IVC

Any T

Any N

M1

Anaplastic carcinoma  未分化癌

IVA

T4a

Any N

M0

IVB

T4b

Any N

M0

IVC

Any T

Any N

M1

 

 

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严佶祺 主任医师
上海瑞金医院 普外科
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