AJCC癌症分期手册第八版补充表格

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"AJCC Cancer Staging Form Supplement.pdf 是美国癌症联合委员会(AJCC)第八版癌症分期手册的补充材料，包含104份可打印的分期表格，用于记录美国外科医师学会(ACS)发布的每一种独特的分期系统。这些表格旨在帮助医生记录肿瘤(T)、淋巴结(N)和转移(M)类别，预后阶段组，额外的预后因素，组织学分级以及其他关键信息。它们在医疗记录中记录信息和医生与癌症登记员之间传递信息时非常有用。" AJCC癌症TNM分期是临床医学中评估恶性肿瘤严重程度和预后的重要工具。T代表原发肿瘤的大小和侵犯程度，N表示局部淋巴结的受累情况，而M则表示是否存在远处转移。这些分类的组合决定了患者的总阶段，从而指导治疗决策和预测生存率。这些分期表格可以在患者治疗的不同阶段使用，如治疗前、手术后所有分期评估完成时，或在复发时。每一步骤都建议使用单独的表格以清晰地记录每个阶段的基础。如果所有时间点的信息记录在同一表格上，必须明确标注每个元素的分期依据。 AJCC癌症分期手册第八版的原则详细阐述了完整的分期规则。对于特定疾病的分期，应始终参照手册中的相应章节，因为这些表格并不能代表所有疾病的所有规则、例外和指示。手册提供了疾病特异性的分类指南，确保了临床医生在对患者进行准确分期时有明确的参考。 AJCC癌症分期系统的重要性在于其标准化的方法，它使得不同医疗机构的医生可以对同一癌症病例进行一致的评估，从而促进研究、比较结果并改进治疗方法。此外，它还促进了患者之间的信息共享，确保了癌症登记员能够准确跟踪癌症的发展和治疗效果，为公共卫生决策提供数据支持。 AJCC癌症分期表格是医生和癌症登记员的重要工具，它们用于收集、记录和传播关于患者癌症状态的关键信息，确保了患者在整个治疗过程中的分期信息完整性和准确性。这些表格的使用有助于优化患者护理，推动临床研究，并促进癌症管理的持续改进。

6. Cervical Lymph Nodes and Unknown Primary Tumors of the Head and Neck

Hospital Name/Address

Patient Name/Information

Page 3 of 5

4.2.2 Pathological N (pN)

These criteria apply to patients who are treated surgically with a cervical lymph node dissection.



pN Category

pN Criteria

Regional lymph nodes cannot be assessed

No regional lymph node metastasis

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(−)

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE(+);

or larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−);

or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(−);

or in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(−)

N2a

Metastasis in a single ipsilateral node 3 cm or less in greatest dimension and ENE(+);

or a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−)

N2b

Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension and ENE(−)

N2c

Metastases in bilateral or contralateral lymph node(s), none larger than 6 cm in greatest dimension and ENE(−)

Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−);

or metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+);

or multiple ipsilateral, contralateral, or bilateral nodes any size and ENE(+) in any node;

or a single contralateral node of any size and ENE(+)

N3a

Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−)

N3b

Metastasis in a single ipsilateral node larger than 3 cm in greatest dimension and ENE(+);

or multiple ipsilateral, contralateral, or bilateral nodes any size and ENE(+) in any node;

or a single contralateral node of any size and ENE(+)

Note: Midline nodes are considered ipsilateral nodes. ENE detected on histopathologic examination is designated as ENE

(microscopic ENE ≤ 2

mm) or ENE

(macroscopic ENE > 2 mm). Both ENE

and ENE

qualify as ENE(+) for definition of pN.

Note: A designation of “U” or “L” may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the

lower border of the cricoid (L). Similarly, clinical and pathological ENE should be recorded as ENE(−) or ENE(+).



N Suffix

Definition

(sn)

Select if regional lymph node metastasis identified by SLN biopsy only.

(f)

Select if regional lymph node metastasis identified by FNA or core needle biopsy only.

Metastasis above the lower border of the cricoid

Metastasis below the lower border of the cricoid

4.3 Definition of Distant Metastasis (M)

The terms pM0 and MX are NOT valid categories in the TNM system. Assignment of the M category for clinical classification may be cM0, cM1,

or pM1. Any of the M categories (cM0, cM1, or pM1) may be used with pathological stage grouping.



M Category

M Criteria

cM0

No distant metastasis

cM1

Distant metastasis

pM1

Distant metastasis, microscopically confirmed

5 AJCC Prognostic Stage Groups

Always refer to the specific chapter for rules on clinical and pathological classification of this disease.



When T is…

And N is…

And M is…

Then the stage group is…

III

IVA

IVB

Any N

IVC

7. Oral Cavity

Hospital Name/Address

Patient Name/Information

Page 1 of 6

1 Terms of Use

The cancer staging form is a specific document in the patient record; it is not a substitute for documentation of history, physical examination,

and staging evaluation, or for documenting treatment plans or follow-up. The staging forms available in conjunction with the AJCC Cancer

Staging Manual, Eighth Edition may be used by individuals without permission from the ACS or the publisher. They cannot be sold, distributed,

published, or incorporated into any software (including any electronic record systems), product, or publication without a written license

agreement with ACS. The forms cannot be modified, changed, or updated without the express written permission of ACS.

2 Instructions

See Principles of Cancer Staging (Chapter 1) of the AJCC Cancer Staging Manual, Eighth Edition for complete staging rules. Always refer to the

respective chapter in the Manual for disease-specific rules for classification, as this form is not representative of all rules, exceptions and

instructions for this disease.

This form may be used by physicians to record data on T, N, and M categories; prognostic stage groups; additional prognostic factors; cancer

grade; and other important information. This form may be useful for recording information in the medical record and for communicating

information from physicians to the cancer registrar.

The staging form may be used to document cancer stage at different points in the patient’s care

and during the course of therapy, including

before therapy begins, after surgery and completion of all staging evaluations, or at the time of recurrence. It is best to use a separate form for

each time point staged along the continuum for an individual cancer patient. However, if all time points are recorded on a single form, the

staging basis for each element should be identified clearly.

This form may provide more data elements than required for collection by standard setters such as NCI SEER, CDC NPCR, and CoC NCDB.

3 Time of Classification (select one):



Classification

Definition

cTNM or TNM

Clinical Classification: Used for all patients with cancer identified before treatment. It is composed of diagnostic

workup information, until first treatment, including clinical history and symptoms, physical examination, imaging,

endoscopy, biopsy of the primary site, biopsy or excision of a single regional node or sentinel nodes, or sampling of

regional nodes, with clinical T, biopsy of distant metastatic site, surgical exploration without resection, and other

relevant examinations

pTNM

Pathological Classification: Used for patients if surgery is the first definitive therapy. Composed of information from

diagnostic workup from clinical staging combined with operative findings, and pathology review of resected surgical

specimens

ycTNM

Posttherapy Clinical Classification: after primary systemic and/or radiation therapy, or after neoadjuvant therapy and

before planned surgery. Criteria: First therapy is systemic and/or radiation therapy

ypTNM

Posttherapy Pathological Classification: Used for staging after neoadjuvant therapy and planned post neoadjuvant

therapy surgery. Criteria: First therapy is systemic and/or radiation therapy and is followed by surgery.

rTNM

Recurrence or Retreatment Classification: Used for assigning stage at time of recurrence or progression until

treatment is initiated.

aTNM

Autopsy Classification: Used for cancers not previously recognized that are found as an incidental finding at autopsy,

and not suspected before death (i.e., this classification does not apply if an autopsy is performed in a patient with a

previously diagnosed cancer).

This form continues on the next page.

7. Oral Cavity

Hospital Name/Address

Patient Name/Information

Page 2 of 6

4 Definitions of AJCC TNM

Always refer to the specific chapter for explicit instructions on clinical and pathological classification for this disease.

4.1 Definition of Primary Tumor (T)



T Category

T Criteria

Primary tumor cannot be assessed

Tis

Carcinoma in situ

Tumor ≤ 2 cm with depth of invasion (DOI)* ≤ 5 mm

Tumor ≤ 2 cm with DOI* > 5 mm

or tumor > 2 cm and ≤ 4 cm with DOI* ≤ 10 mm

Tumor > 2 cm and ≤ 4 cm with DOI* > 10 mm

or tumor > 4 cm with DOI* ≤ 10 mm

Moderately advanced or very advanced local disease

T4a

Moderately advanced local disease

Tumor > 4 cm with DOI* > 10 mm

or tumor invades adjacent structures only (e.g., through cortical bone of the mandible or maxilla or involves the

maxillary sinus or skin of the face)

Note: Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as

T4.

T4b

Very advanced local disease

Tumor invades masticator space, pterygoid plates, or skull base and/or encases the internal carotid artery

*DOI is depth of invasion and not tumor thickness.



T Suffix

Definition

(m)

Select if synchronous primary tumors are found in single organ.

4.2 Definition of Regional Lymph Node (N)

4.2.1 Clinical N (cN)



cN Category

cN Criteria

Regional lymph nodes cannot be assessed

No regional lymph node metastasis

Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension ENE(−)

Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension and ENE(−);

or metastases in multiple ipsilateral lymph nodes, none larger than 6 cm in greatest dimension and ENE(−);

or in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension, and ENE(−)

N2a

Metastasis in a single ipsilateral node larger than 3 cm but not larger than 6 cm in greatest dimension, and ENE(−)

N2b

Metastases in multiple ipsilateral nodes, none larger than 6 cm in greatest dimension, and ENE(−)

N2c

Metastases in bilateral or contralateral lymph nodes, none larger than 6 cm in greatest dimension, and ENE(−)

Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−);

or metastasis in any node(s) and clinically overt ENE(+)

N3a

Metastasis in a lymph node larger than 6 cm in greatest dimension and ENE(−)

N3b

Metastasis in any node(s) and clinically overt ENE(+)

Note: A designation of “U” or “L” may be used for any N category to indicate metastasis above the lower border of the cricoid (U) or below the

lower border of the cricoid (L). Similarly, clinical and pathological ENE should be recorded as ENE(−) or ENE(+).



N Suffix

Definition

(sn)

Select if regional lymph node metastasis identified by SLN biopsy only.

(f)

Select if regional lymph node metastasis identified by FNA or core needle biopsy only.

Metastasis above the lower border of the cricoid

Metastasis below the lower border of the cricoid

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