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美国癌症联合委员会肝门部胆管癌分期系统（第8版）更新解读

毛    谅1，陈    骏2，孙士全1，王可欣3，仇毓东1   

  1. 1.南京大学医学院附属鼓楼医院肝胆胰外科，江苏南京 210008；2.南京大学医学院附属鼓楼医院病理科，江苏南京 210008；3.南京医科大学第一临床医学院，江苏南京 210029
  • 出版日期:2017-05-01 发布日期:2017-04-28

  • Online:2017-05-01 Published:2017-04-28

摘要：

美国癌症联合委员会（AJCC）第8版癌症分期系统将于2018-01-01在全球启动执行。在该版分期中，关于肝门部胆管癌的T分期和N分期以及系统分期均较前版有较大的改动。主要更新为：将Bismuth Ⅳ型从T4分期中剔除，N分期以区域淋巴结转移数目进行分期（N1为1～3枚区域淋巴结转移，N2为≥4枚区域淋巴结转移），以及在系统分期中下调T分期，上调N分期（T4从ⅣA期调整为ⅢB期，N1从ⅢB期调整为ⅢC期，N2划分为ⅣA期）。以上更新体现了目前外科治疗对于肝门部胆管癌的进步及局限。一方面，外科手术技术的提高已经可以使T4期病人获得根治性手术切除的机会；另一方面，对于淋巴结转移病人，单靠外科手术已无法进一步提高疗效。借助多学科参与、综合诊疗的模式可能是提高肝门部胆管癌淋巴结转移疗效的一种途径。

关键词: 美国癌症联合委员会, 肝门部胆管癌, 肿瘤分期, 循证医学

Abstract:

The interpretation of update on the 8th edition of the AJCC perihilar cholangiocarcinoma staging system                   MAO Liang*, CHEN Jun, SUN Shi-quan, et al.*Department of Hepatobiliary and Pancreatic Surgery, Drum Tower Hospital, Nanjing210008,China
Corresponding author: QIU Yu-dong, E-mail: yudongqiu510@163.com
Abstract    The eighth edition of cancer staging system published by AJCC will be executed all over the world in Jan 1,2018. The T stage, N stage and system stage of perihilar cholangiocarcinoma have some important update compared to last edition. In T stage, the Bismuth type Ⅳ has been removed from T4 category. N category was reclassified based on number of positive nodes to N1(one to three positive nodes) and N2(four or more positive nodes). T4 tumor was changed from Stage ⅣA to Stage ⅢB, N1 category was changed from Stage ⅢB to ⅢC, and N2 category is classified as Stage ⅣA. These updates reflect the progress and limit of surgery in perihilar cholangiocarcinoma: T4 patients may benefit from resection, while positive nodes will limit surgical effect. The multidisciplinary teamworking and comprehensive treatment may increase the therapy effect in nodes positive patients.

Key words: American Joint Committee on Cancer, perihilar cholangiocarcinoma, tumor staging, evidence-based medicine