肺癌分期的当前争议

Current Controversies in Lung Cancer Staging.

作者信息

Carter Brett W, Godoy Myrna C B, Wu Carol C, Erasmus Jeremy J, Truong Mylene T

机构信息

Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.

出版信息

J Thorac Imaging. 2016 Jul;31(4):201-14. doi: 10.1097/RTI.0000000000000213.

Abstract

Lung cancer remains the leading cause of cancer-related mortality in the United States, and accurate staging of disease plays an important role in the formulation of treatment strategies and optimization of patient outcomes. The International Association for the Study of Lung Cancer has recently proposed changes to the upcoming eighth edition of the tumor, node, and metastasis (TNM-8) staging system used for lung cancer. This revised classification is based on significant differences in patient survival identified on analysis of a new large international database of lung cancer cases. Key changes include: further modifications to the T descriptors based on 1 cm increments in tumor size; grouping of tumors resulting in partial or complete lung atelectasis/pneumonitis; grouping of tumors involving a main bronchus with respect to distance from the carina; reassignment of diaphragmatic invasion; elimination of mediastinal pleural invasion as a descriptor; and further subdivision of metastatic disease into distinct descriptors based on the number of extrathoracic metastases and involved organs. Because of these changes, several new stage groups have been developed, and others have shifted. Although TNM-8 represents continued improvement upon modifications previously made to the staging system, reflecting an evolving understanding of tumor behavior and patient management, several limitations and unaddressed issues persist. Understanding the proposed revisions to TNM-8 and awareness of key limitations and potential controversial issues still unaddressed will allow radiologists to accurately stage patients with lung cancer and optimize treatment decisions.

摘要

肺癌仍是美国癌症相关死亡的主要原因,准确的疾病分期在制定治疗策略和优化患者预后方面发挥着重要作用。国际肺癌研究协会最近对即将推出的用于肺癌的第八版肿瘤、淋巴结和转移(TNM-8)分期系统提出了修改建议。这一修订后的分类是基于对一个新的大型国际肺癌病例数据库分析中发现的患者生存显著差异。主要变化包括:根据肿瘤大小以1厘米为增量对T描述符进行进一步修改;对导致部分或完全肺不张/肺炎的肿瘤进行分组;根据肿瘤累及主支气管与隆突的距离进行分组;重新划定膈肌侵犯;取消将纵隔胸膜侵犯作为一个描述符;并根据胸外转移灶数量和受累器官将转移性疾病进一步细分为不同的描述符。由于这些变化,已经形成了几个新的分期组,其他分期组也发生了变动。尽管TNM-8在之前对分期系统的修改基础上持续改进,反映了对肿瘤行为和患者管理的不断演变的认识,但仍存在一些局限性和未解决的问题。了解TNM-8的拟议修订内容以及认识到关键局限性和仍未解决的潜在争议问题,将使放射科医生能够准确地对肺癌患者进行分期并优化治疗决策。

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