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第8版《美国癌症联合会肿瘤分期手册》肝内胆管细胞癌TNM分期解读
陈骏
毛谅
何健
孔炜伟
贺奇彬
史炯
沈洁
刘芩
唐敏
仇毓东
作者及单位信息
·
DOI： 10.3760/cma.j.issn.1673-9752.2017.04.003
Interpretation of the TNM classification for intrahepatic cholangiocarcinoma in the American Joint Committee on Cancer cancer staging manual (8th edition)
Chen Jun
Mao Liang
He Jian
Kong Weiwei
He Qibin
Shi Jiong
Shen Jie
Liu Qin
Tang Min
Qiu Yudong
Authors Info & Affiliations
Chen Jun
Department of Pathology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
Mao Liang
He Jian
Kong Weiwei
He Qibin
Shi Jiong
Shen Jie
Liu Qin
Tang Min
Qiu Yudong
·
DOI： 10.3760/cma.j.issn.1673-9752.2017.04.003
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摘要

肝内胆管细胞癌(ICC)是肝脏第2常见的原发性恶性肿瘤且预后非常差。为了更好地指导临床治疗，美国癌症联合会(AJCC)在第7版《AJCC肿瘤分期手册》中首次将ICC与肝细胞癌分开，单独设置章节，反映了ICC的危险因素与肝细胞癌的差异性。而最近出版的第8版《AJCC肿瘤分期手册》中进一步对ICC的TNM分期系统进行了更新。其中，不再以肿瘤大体分型特征进行T分期，同时淋巴结转移(N1期)被归入ⅢB期，而非第7版中归入Ⅳ期。另外还对区域淋巴结和远处转移等做出了明确定义，并推荐至少清扫6枚区域淋巴结方可进行准确的N分期。第8版AJCC肝内胆管细胞癌分期系统的优势在于能够更准确地显示患者预后，对临床具有更高的指导价值。

肝内胆管细胞癌;TNM分期;第8版;美国癌症联合会;解读
ABSTRACT

Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer with a very poor prognosis. In order to guide better clinical management of ICC patients, the American Joint Committee on Cancer (AJCC) cancer staging manual (7th edition) have established a unique TNM staging scheme for separating ICC from hepatocellular carcinoma (HCC) for the first time, and reflected a difference between risk factor of ICC and HCC. This TNM staging system for ICC has been most recently updated by the AJCC cancer staging manual (8th edition), in which T staging has been redefined without gross features, and lymph node metastasis (N1) in N staging has been grouped as stage ⅢB, but not stage Ⅳ as required by the 7th edition of AJCC cancer staging manual. In addition, region lymphatic and distant metastases have been clearly redefined by the AJCC cancer staging manual (8th edition) that also requires recovering at least 6 lymph nodes for the N staging scheme. The apparent advantages of the AJCC cancer staging manual (8th edition) for ICC pathologic staging may better stratify the prognosis of ICC patients and provide an improved guidance in clinical practice.

Intrahepatic cholangiocarcinoma;TNM Classification;Eighth edition;Ameri-can Joint Committee on Cancer;Under-standing
Qiu Yudong, Email: mocdef.3ab61015uiqgnoduy
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引用本文

陈骏,毛谅,何健,等. 第8版《美国癌症联合会肿瘤分期手册》肝内胆管细胞癌TNM分期解读[J]. 中华消化外科杂志,2017,16(4)：330-335.

DOI:10.3760/cma.j.issn.1673-9752.2017.04.003

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肿瘤的TNM分期系统描述了肿瘤的生长，侵袭和转移等信息，对判断患者预后和指导肿瘤临床治疗起了非常重要的作用。美国癌症联合会(AJCC)自1977年出版第1版肿瘤分期手册以来，2016年底已出版第8版，由于该分期系统简便易掌握，为内外科临床医师广泛采用。其中，肝内胆管细胞癌(intrahepatic cholangiocarcinoma，ICC)是一种高度致死性肿瘤，发病率低[(0.3～1.0)/100 000人·年]，病因存在种族与地域差异，手术仍是唯一公认的有效治疗方式 [ 1 , 2 , 3 ]。直到2002年第6版AJCC分期中仍未分出专门章节阐述，仅将ICC并入肝细胞癌章节，与肝细胞癌使用相同的TNM分期方法。ICC作为第2常见的肝脏原发性肿瘤，其病因、发病机制和侵袭转移方式与肝细胞癌显著不同。因此，2010年出版的AJCC第7版TNM分期中，胆管癌依据其发生部位被分为肝内胆管细胞癌，肝门部胆管癌和远端胆管癌，并分别设置章节进行有针对性的TNM分期。然而，在第7版的ICC分期中存在不足，比如区域淋巴结的清扫是否必要，如何评价T4分期，M1期的适用范围模糊等。2016年底AJCC发布了第8版TNM分期，并依据惯例出版了第8版《AJCC肿瘤分期手册》。新版的TNM分期延续了第7版对ICC单独分期，并进行了内容更新。目前，我国各大医院对肿瘤治疗多参照AJCC的TNM分期标准。AJCC第8版的TNM分期系统更新对ICC的影像学评估、手术规划、病理学诊断和综合治疗等均有重大影响。笔者所在的多学科团队长期致力于肝胆肿瘤的诊断与治疗，仔细研读第7版和第8版《AJCC肿瘤分期手册》中ICC及相关章节，结合相应文献和临床工作中的经验，有针对性地解读AJCC第8版中ICC章节内容。
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