口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读

doi:10.19438/j.cjoms.2018.06.010

中国口腔颌面外科杂志 ›› 2018, Vol. 16 ›› Issue (6): 533-546.doi: 10.19438/j.cjoms.2018.06.010

口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读

尚伟^1,2,*, 郑家伟^3,*

1.青岛大学附属医院口腔颌面外科,山东青岛 266003;
2.青岛大学口腔医学院,山东青岛 266003;
3.上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科,上海 200011;

收稿日期:2018-08-10 出版日期:2018-11-20 发布日期:2019-01-11
通讯作者: 尚伟,E-mail：liweishang@126.com;郑家伟,E-mail：davidzhengjw@hotmail.com。^*共同通信作者
作者简介:尚伟（1963-）,男,教授,主任医师,博士研究生导师

Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx

SHANG Wei^1,2, ZHENG Jia-wei³

1.Department of Oral and Maxillofacial Surgery, the Affiliated Hospital of Qingdao University. Qingdao 266003;
2. School of Stomatology, Qingdao University. Qingdao 266003, Shandong Province;
3.Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2018-08-10 Online:2018-11-20 Published:2019-01-11

摘要/Abstract

摘要： 美国癌症联合委员会《AJCC肿瘤分期手册》与美国国立综合癌症网(NCCN）肿瘤学临床实践指南已广泛用于临床实践中。NCCN肿瘤诊治指南与TNM分期密切相关,指南为不同TNM分期的肿瘤制定了较为详细的诊治标准,作为依据指导临床应用。2017年第8版口腔及口咽癌TNM分期新增了较多内容,如侵袭深度（DOI）、淋巴结外扩展（ENE）、人乳头瘤病毒（HPV）等指标用于了新的分期中,并且为HPV相关的口咽癌制定了一个新的TNM分期。2018年版NCCN口腔与口咽癌指南及时反映了第8版口腔及口咽癌TNM分期中新的变化,同时亦为HPV相关的口咽癌制定了相应的诊治指南。新的TNM分期及NCCN诊治指南对口腔与口咽癌患者诊疗策略的制定及治疗方案的选择具有较大的指导意义。为了临床工作的需要,本文结合两者的变化进行了部分解读。

关键词: AJCC, TNM分期, NCCN, 治疗指南, 口腔癌, 口咽癌

Abstract: The AJCC Cancer Staging Manual and the NCCN Clinical Practice Guidelines in Oncology are widely used in clinical practice. NCCN diagnosis and treatment guidelines are closely related to TNM staging, and the guidelines provide more detailed diagnostic and therapeutic criteria for cancers with different TNM staging as a basis for guiding clinical application. The 8th edition TNM staging system for cancers of the oral cavity and oropharynx introduced a number of significant changes, such as depth of invasion(DOI), extranodal extension (ENE), human papillomavirus(HPV) and other indicators were used in the new stage, and a new chapter describing the staging of HPV-associated oropharyngeal cancers had been added. The 2018 NCCN guidelines for cancers of the oral cavity and oropharynx timely reflected the new changes in the 8th edition TNM staging, and the panel also created separate algorithms for HPV-associated (p16-positive) oropharyngeal cancer. The new TNM staging and NCCN guidelines are of great guiding significance in the treatment strategies and plans for patients with cancers of the oral cavity and oropharynx. The treatment recommendations were provided and the interpretation was made for the needs of clinical practice in this paper.

Key words: AJCC, TNM classification, NCCN, Treatment guideline, Oral cavity cancer, Oropharyngeal, Cancer

中图分类号:

尚伟, 郑家伟. 口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读[J]. 中国口腔颌面外科杂志, 2018, 16(6): 533-546.

SHANG Wei, ZHENG Jia-wei. Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx[J]. China J Oral Maxillofac Surg, 2018, 16(6): 533-546.

参考文献

[1] Amin MB, Edge SB, Greene FL, et al.AJCC cancer staging manual[M]. 8th Ed. New York: Springer, 2017.
[2] The NCCN clinical practice guidelines in oncology, head and neck cancers[M]. Version 2. National Comprehensive Cancer Network Inc., 2018.
[3] Ebrahimi A, Gil Z, Amit M, et al.Primary tumor staging for oral cancer and a proposed modification incorporating depth of invasion: an international multicenter retrospective study[J]. JAMA Otolaryngol Head Neck Surg, 2014, 140(12): 1138-1148.
[4] Lydiatt WM, Patel SG, O'Sullivan B, et al. Head and neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual[J]. CA Cancer J Clin, 2017, 67(2): 122-137.
[5] Ebrahimi A, Clark JR, Amit M, et al.Minimum nodal yield in oral squamous cell carcinoma: defining the standard of care in a multicenter international pooled validation study[J]. Ann Surg Oncol, 2014, 21(9): 3049-3055.
[6] Prabhu RS, Hanasoge S, Magliocca KR, et al.Extent of pathologic extracapsular extension and outcomes in patients with nonoropharyngeal head and neck cancer treated with initial surgical resection[J]. Cancer, 2014, 120(10): 1499-1506.
[7] Wreesmann VB, Katabi N, Palmer FL, et al.Influence of extracapsular nodal spread extent on prognosis of oral squamous cell carcinoma[J]. Head Neck, 2016, 38(Suppl 1): E1192-1199.
[8] Ang KK, Harris J, Wheeler R, et al.Human papillomavirus and survival of patients with oropharyngeal cancer[J]. N Engl J Med, 2010, 363(1): 24-35.
[9] Ebrahimi A, Amit M, Yen TC, et al.Comparison of the American Joint Committee on Cancer NI versus N2a nodal categories for predicting survival and recurrence in patients with oral cancer: Time to acknowledge an arbitrary distinction and modify the system[J]. Head Neck, 2016, 38(1): 135-139.
[10] Lewis JS Jr, Beadle B, Bishop JA, et al.Human papillomavirus testing in head and neck carcinomas: Guideline from the College of American Pathologists[J]. Arch Pathol Lab Med, 2018, 142(5): 559-597.
[11] Maxwell JH, Thompson LD, Brandwein-Gensler MS, et al.Early oral tongue squamous cell carcinoma: sampling of margins from tumor bed and worse local control[J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(12): 1104-1110.
[12] Hinni ML, Ferlito A, Brandwein-Gensler MS, et al.Surgical margins in head and neck cancer: a contemporary review[J]. Head Neck, 2013, 35(9): 1362-1370.
[13] Brandwein-Gensler M, Smith RV, Wang B, et al.Validation of the histologic risk model in a new cohort of patients with head and neck squamous cell carcinoma[J]. Am J Surg Pathol, 2010, 34(5): 676-688.
[14] Li Y, Bai S, Carroll W, et al.Validation of the risk model: high-risk classification and tumor pattern of invasion predict outcome for patients with low-stage oral cavity squamous cell carcinoma[J]. Head Neck Pathol, 2013, 7(3): 211-223.
[15] Chinn SB, Spector ME, Bellile EL, et al.Impact of perineural invasion in the pathologically N0 neck in oral cavity squamous cell carcinoma[J]. Otolaryngol Head Neck Surg, 2013, 149(6): 893-899.
[16] Civantos FJ, Zitsch RP, Schuller DE, et al.Sentinel lymph node biopsy accurately stages the regional lymph nodes for T1-T2 oral squamous cell carcinomas: results of a prospective multi-institutional trial[J]. J Clin Oncol, 2010, 28(8): 1395-1400.
[17] Alkureishi LW, Ross GL, Shoaib T, et al.Sentinel node biopsy in head and neck squamous cell cancer: 5-year follow-up of a European multicenter trial[J]. Ann Surg Oncol, 2010, 17(9): 2459-2464.
[18] Govers TM, Hannink G, Merkx MA, et al.Sentinel node biopsy for squamous cell carcinoma of the oral cavity and oropharynx: a diagnostic meta-analysis[J]. Oral Oncol, 2013, 49(8): 726-732.
[19] D'Cruz AK, Vaish R, Kapre N, et al. Elective versus therapeutic neck dissection in node-negative oral cancer[J]. N Engl J Med, 2015, 373(6): 521-529.

口腔及口咽癌新版TNM分期与NCCN诊治指南部分解读

Interpretation of the new TNM classification and the NCCN guidelines for cancers of the oral cavity and oropharynx

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈伟良. 延长垂直下斜方肌岛状肌皮瓣修复重建大型头颈部缺损[J]. 中国口腔颌面外科杂志, 2023, 21(1): 1-10.
[2]	周瑜, 翁海燕, 司呈云, 段贤捷, 安星妃, 章礼玉. 第8版TNM分期修订版对早期口腔黏膜鳞癌患者预后及危险分层作用的临床研究[J]. 中国口腔颌面外科杂志, 2022, 20(6): 571-576.
[3]	吴亚平, 高嘉敏, 孙树洋. HPV相关口咽癌诊疗进展[J]. 中国口腔颌面外科杂志, 2022, 20(6): 599-606.
[4]	吴梓谦, 殷玉兰, 杨文玉, 张贞, 侯黎莉, 王磊. 口腔癌患者术后舌神经功能障碍与生活质量的关系评价[J]. 中国口腔颌面外科杂志, 2022, 20(5): 449-454.
[5]	樊文慧, 劳峥, 石慧烽, 毕帆, 涂文勇, 胡海生. 3D打印可分离式口腔支架在口腔癌放疗中的摆位准确性研究[J]. 中国口腔颌面外科杂志, 2022, 20(5): 466-470.
[6]	李恒勇, 杨宋, 周凯, 孔钰, 李洁莹, 李贵忠, 葛胜优, 杨小琛, 冯元勇, 宋凯, 尚伟. 336例HPV相关性与非相关性口咽鳞癌患者生存分析[J]. 中国口腔颌面外科杂志, 2022, 20(4): 378-383.
[7]	朱博文, 庄海, 毛秋怡, 卜寿山. 4种评分系统判断口腔癌患者术后气管切开需求的准确性评价[J]. 中国口腔颌面外科杂志, 2022, 20(2): 129-134.
[8]	肖育栋, 郭凯欣, 杨乐, 邓威, 曾滨, 张思恩, 劳小媚, 廖贵清, 梁玉洁. 369例口腔癌患者汉语普通话语音数据库的建立与初步评价[J]. 中国口腔颌面外科杂志, 2022, 20(2): 151-157.
[9]	周凯, 李恒勇, 齐晓杰, 葛胜优, 孔钰, 宋凯, 冯元勇, 侯峰, 史海磊, 蒋艳霞, 尚伟. 口腔癌浸润深度对改进肿瘤TNM分期及预后评价的影响[J]. 中国口腔颌面外科杂志, 2021, 19(2): 138-145.
[10]	姚麟, 郭萌萌, 邓璋, 曾威. 改良负压封闭引流术在游离皮瓣修复术后供区植皮中的应用[J]. 中国口腔颌面外科杂志, 2021, 19(2): 163-166.
[11]	潘梦琪, 李志勇, 赵文权. ASCO指南解读：“口腔和口咽鳞状细胞癌颈部管理”[J]. 中国口腔颌面外科杂志, 2021, 19(2): 177-180.
[12]	张鑫睿, 江旖婷, 张晗之, 张美芳, 张海峰, 孙娟, 任国欣. 28例晚期口腔鳞癌患者新辅助化疗围化疗期营养状况及生活质量评估[J]. 中国口腔颌面外科杂志, 2020, 18(6): 516-520.
[13]	王延，蒋通辉，庄海，张继生，卜寿山. 术前肠内营养支持治疗在口腔鳞癌患者加速康复中的应用[J]. 中国口腔颌面外科杂志, 2020, 18(2): 122-126.
[14]	叶海春, 高先连, 任阳, 李丽. 早期系统化康复训练在口腔癌术后游离皮瓣修复患者中应用效果的meta分析[J]. 中国口腔颌面外科杂志, 2020, 18(2): 171-176.
[15]	尚伟, 郑家伟. 2019年NCCN口腔口咽癌诊疗指南更新解读[J]. 中国口腔颌面外科杂志, 2019, 17(6): 481-485.