肺癌的相关知识（二）：肺癌TNM分期系统

引言

肺癌(NSCLC)TNM分期系统是国际公认的用于描述病变范围的系统。TNM系统将肿瘤特征与疾病分期联系起来，疾病分期与生存情况和治疗推荐相关联。TNM分期的目的是提供可便于沟通的癌症解剖范围描述，协助制定治疗决策，并作为预后指标。TNM分期可用于对病例进行比较，特别是对不同治疗方案结局的比较。在临床实践中，TNM分期与患者的独特临床特征相结合，并且在某些情况下，TNM分期结合了肿瘤本身的分子学特征，可指导预后评估和治疗选择。

区别NSCLC和SCLC的基本原理

由于临床特征、治疗方法和临床结局的差异，肺癌被细分为两个主要类别，即非小细胞肺癌(non-small cell lung cancer, NSCLC)和小细胞肺癌(small cell lung carcinoma, SCLC)。一般来说，SCLC的生长速度更快，更常位于中央和纵隔，更早出现胸腔外转移，总生存时间更短。小细胞癌通常使用简化的系统进行分期和治疗，分为临床局限期或临床广泛期疾病。

肺癌TNM分期系统简介

TNM分期系统是根据原发肿瘤特点(T)、区域淋巴结受累存在与否(N)、以及远处转移的存在与否(M)对肿瘤进行分类。TNM系统不包括肺癌的分子学肿瘤特征。肿瘤的总体综合分期(Ⅰ至Ⅳ期)由T、N、M等级组合所决定。如果在任何一项特征中肿瘤的范围不能进行评估，那么在此特征后附加后缀“X”(例如，TX、NX或MX)。临床-诊断分期、手术-病理分期、复治分期和尸检分期所用的TNM分期系统相同。

本文主要参考UpToDate临床顾问《肺癌TNM分期系统》一文，包括的参考文献如下：

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