国际抗癌联盟及美国肿瘤联合会胃癌TNM分期系统(第8版)简介及解读

The Union for International Cancer Control(UICC) and the American Joint Committee on Cancer(AJCC) gastric cancer TNM staging system(8th edition) explanation and elaboration

2016年10月,国际抗癌联盟(UICC)及美国肿瘤联合会(AJCC)颁布了第8版胃癌TNM分期系统。新版分期系统创新性地将单一分期系统更改为包括临床分期(c TNM)、病理分期(p TNM)及新辅助治疗后病理分期(yp TNM)的三标准综合分期系统,临床医师可依据不同的临床状况进行选择,从而为临床决策及预后判断提供更为精准的依据。此外,第8版胃癌TNM分期系统的主要更新还包括:对胃食管结合部及贲门癌分期标准的选择作出了更明确的定义,N3的两个亚组N3a、N3b作为独立组别参与分期,并对原Ⅲ期部分亚组的分期定义也进行了一定范围的变更。不过,第8版胃癌TNM分期系统的实际价值仍有待于更广泛的临床应用加以验证,同时,基于分子生物学进展的胃癌风险预测模型也仍然没能出现。因此,第8版胃癌TNM分期系统仍然是通向胃癌精准医疗时代的一个过渡工具。

The Union for International Cancer Control （UICC） and the American Joint Committee on Cancer （AJCC） have issued the Eighth Edition of TNM staging system manual in October 2016. The updated version made evidence-based, prominent revisions in cancer stage classification system. Specifically, the old TNM staging system based on post-operative pathological examination was replaced by a more sophisticated staging system including clinical staging （cTNM）, pathological staging （pTNM）, and neo-adjuvant post-treatment staging （ypTNM）. These revisions help oncologists and other clinicians better determine the stage of gastric cancer patients according to their conditions and treatments. Consequentially, appropriate individualized anti-cancer treatment could be made possible for each patient. Also, the Eighth Edition revised the guidance in staging gastroesophageal junction cancer and cardia cancer. Another update is N3a and N3b, separated from N3, work as two independent groups in staging system. Comparing to the Seventh Edition, some adjustment was made in sub-classifying patients of stage III. The usefulness and appropriateness of the new updates need clinical validation around the world. Although a risk prediction model incorporating the recent advancement of molecular biology has not been developed as expected, the Eighth Edition provides a useful tool for clinicians in the transition to precision treatment for gastric cancer.