非小细胞肺癌中英分期.docVIP

非小细胞肺癌分期 TNM-classificationTNM分期（感觉有些新同僚不是太注意分期，只是简单的说明一下早期还是晚期，其实把分析看得越细致，我们在处理的时候可能会获益更多。）NSCLC includes adenocarcinoma (35-40%), squamous cell carcinoma (25-30%) and large cell carcinoma (10-15%).非小细胞肺癌包括35-40%的腺癌，25-30%的鳞状细胞癌和10-15%大细胞癌。NSCLC is staged according to the TNM-staging system.?TNM subsets are grouped into certain stages, because these patients share similar prognostic and therapeutic options.?TNM分期法把该病分成几期，主要是为了将预后和治疗方法相似的病人归类。For instance all stage IIIA patients have a 5 year-survival of 10%.例如：IIIa期病人的5年生存率只有10%。In the table on the left resectable stages are indicated in green and unresectable stages are indicated in red. 表里，红的是不可切除，绿的为可切除。Stage IIIA is possibly resectable, usually after combined-modality therapy consisting of platinum-based chemotherapy and radiation.?IIIa期是可切除的，通常在综合治疗后：包括铂类化疗和放疗。（实际上，在国内，是否可切除在于哪个科先诊断，但是我们需要病人的时候是否优先考虑病人的利益呢？那就看同仁的心了。） Stage IIIB, i.e. any patient who has T4 or N3 disease is virtually unresectable, but in some countries there are subgroups of patients that will get a resection.Evidently all patients with distant metastases (stage IV) are inoperable.IIIb期，T4，N3被认为几乎不能手术切除，除了某些国家采取，很明显，IV不应该手术。? T-staging is best done with CT to determine the local extent and to look for satellite nodules.CT是T分期最好的工具，可以明确局部侵犯和卫星结节。There are advantages if CT precedes bronchoscopy and the information from CT is used by the bronchoscopist.支气管镜前行CT也是必要的。CT however has important limitations in overall staging.总体分期CT有很大的限制。Preoperative predictions with CT differ from operative staging in 45% of cases.Patients are being both over- and understaged.?手术分期后只有45%跟术前CT分期吻合。病人分期可能被高估或者低估。CT staging remains unsatisfactory for detecting hilar (N1) and mediastinal (N2 and N3) lymph node metastases, and for chest wall involvement (T3) or mediastinal invasion (T4), in which sensitivity and specificity can be less than 65%.CT分期不能满意检测肺门（N1）和纵隔（N2和N3）淋巴结转移，并胸壁（T3）侵犯或纵隔侵犯（T4），其敏感性和特异性，低于65％。MR is more useful than CT in the fol