世界卫生组织TNM分期更新内容

TNM Seventh Edition:What’s New,What’s Changed

Communication From the International Union Against Cancer and the American Joint Committee on Cancer

Leslie H Sobin,MD 1and Carolyn pton,MD,PhD 2,3

The seventh edition of the TNM Classification of Malignant Tumors (TNM-7)1,2contains several new and modified

component classifications.The purpose of this communication was to briefly summarize these changes,which became effective in January 2010.Among the new classifications are adrenal cortical carcinoma,appendiceal carcinoma,extrahe-patic bile duct carcinoma,esophagogastric junction carcinoma,gastrointestinal stromal tumors (GISTs),intrahepatic cholangiocarcinoma,melanoma of the upper aerodigestive tract,Merkel cell carcinoma,neuroendocrine tumors of the lung and gastrointestinal tract,and uterine sarcomas.Among the classifications with major alterations are carcinomas of the esophagus,stomach,lung,skin,vulva,and prostate.In addition,there are several general rules that have been modified or established.

MX

The category ‘‘MX:Distant metastasis cannot be assessed’’has been a source of misinterpretation and its use,3especially by pathologists (ie,pMX),has had the unintended consequence of preventing stage grouping by cancer registries.Cancer regis-trars do not stage a case if distant metastasis cannot be assessed.Surgical pathologists,when assessing a resected specimen,usually have sufficient information to provide a pT and a pN classification,but rarely have information regarding distant metastasis.Consequently,they may assign MX,meaning that they cannot assess distant metastasis.However,it is the patient’s clinician,not the pathologist,who is in the position to make this assessment,usually by clinical examination.If there are no obvious signs of metastasis,M0or cM0classifications are appropriate.In other words,once clinically examined,a patient is M0until proven otherwise.If a liver nodule is detected radiographically in a patient with colon carcinoma,the disease may be considered cM1.If the nodule is biopsied and proven malignant,it is pM1;if it is found to be a hemangioma,it is classified as cM0,not pM0,pMX,or cMX.pM0indicates there is no pathological evidence of cancer in the patient,a situation that occurs only after a complete autopsy (and then would be designated as aM0,not pM0).To prevent patholo-gists and clinicians from using MX or pMX,these designations have been deleted from TNM-7,thereby encouraging the assignment of M0and facilitating stage grouping.Cancer registries will be the immediate beneficiaries of this change.Pn:Perineural Invasion

This optional descriptor had been in the TNM Supplement since 2001.4Although it does not affect stage grouping,it is considered in some situations to be an independent prognostic factor.

Isolated Tumor Cells

The subject of isolated tumor cells (ITCs)in regional lymph nodes and distant sites,which originally referred to single cells and small clusters,5has now evolved into a proposal to include a single cluster of <200cells in a single histological

DOI:10.1002/cncr.25537,Received:May 25,2010;Accepted:June 21,2010,Published online July 21,2010in Wiley Online Library ()

Corresponding author:Leslie H Sobin,MD,UICC TNM Committee,4280Massachusetts Avenue NW,Washington,DC 20016-5558;Fax:(301)480-1069;sobin@

1

International Union Against Cancer TNM Prognostic Factors Project,Geneva,Switzerland;2American Joint Committee on Cancer,Chicago,Illinois;3Office of Bio-repositories and Biospecimen Research,National Cancer Institute,Bethesda,Maryland