(① lepidic 優勢, ②浸潤径 5 mm以下を満たさないなら pT1a）
pT1a ≤1 cm
pT1b ≤2 cm
pT1c ≤3 cm
T2 Tumour more than 3 cm but not more than 5 cm;
or tumour with any of the following features:
Involves main bronchus without involvement of the
carina,
or invades visceral pleura
or associated with atelectasis
or obstructive pneumonitis
pT2a Tumour more than 3 cm but not more than 4 cm
pT2b Tumour more than 4 cm but not more than 5 cm
pT3 Tumour more than 5 cm but not more than 7 cm
or directly invades: parietal pleura, chest wall, phrenic nerve,
or parietal pericardium; or separate tumour nodule(s) in the same lobe.
pT4 Tumour more than 7 cm
or of any size that invades any of the following:
diaphragm, mediastinum, heart, great vessels, trachea,
recurrent laryngeal nerve, oesophagus, vertebral body,
carina;
or separate tumour nodule(s) in a different ipsilateral lobe to the
primary
pN1 Station 10≤
pN2 Station 2-9
pM1a Separate tumour nodule(s) in a contralateral lobe;
tumour with pleural or pericardial nodules
or malignant pleural or pericardial effusion
pM1b Single extrathoracic metastasis in a single organ
pM1c Multiple extrathoracic metastasis in a single or multiple organs
Stage IA1 T1mi,T1a N0 M0
Stage IA2 T1b
N0 M0
Stage IA3 T1c
N0 M0
Stage IB T2a
N0 M0
Stage IIA T2b
N0 M0
Stage IIB T1a-c, T2a,b N1 M0
T3
N0 M0
Stage IIIA T1a-c, T2a,b
N2 M0
T3
N1
M0
T4
N0,N1
M0
Stage IIIB T1a-c, T2a,b
N3 M0
T3, T4
N2
M0
Stage IIIC T3, T4
N3
M0
Stage IVA Any T Any N M1a,b
Stage IVB Any T Any N M1c
Stage, TNM, 5-yr survival
IA1, pT1a, 92%
IA2, pT1b, 83%
IA3, pT1c, 77%
IB, pT2a, 68%
IIA, pT2b, 60%
IIB, pT3 or pT1-2pN1, 53%
IIIA, pT4pN0-1 or pT3pN1 or pT1-2pN2, 36%
IIIB, pT3-4pN2 or pT1-2pN3, 26%
IIIC, pT3-4pN3, 13%
IVA M1ab, 10%
IVB M1c, 0%
[Rami-Porta R. JTO 2015]
===========================================================
TNM分類（第7版）
pTis: Carcinoma in
situ
pT1 (胸膜・主気管支へ浸潤しない)
pT1a: ≤ 2 cm, あるいは
腫瘍径に関係なく表層に伸展し浸潤が気管支壁にとどまる
pT1b: >2-3 cm
pT2 (気管分岐部から2 cm以上離れた主気管支への浸潤;
臓側胸膜浸潤;
無気肺か閉塞性肺炎; のいずれかを伴う)
pT2a: ≤ 5 cm
pT2b: >5-7 cm
臓側胸膜浸潤は表面露出でなく弾性板
(弾性線維染色が有用)を越えた場合と定義。
参考(取扱い規約)
PL0 弾性板を越えない
PL1 弾性板を越える
PL2 表面露出
PL3 壁側強膜浸潤
pT3: > 7 cm or [胸壁浸潤; 横隔膜浸潤; 横隔神経浸潤;
縦隔胸膜浸潤; 壁側心膜浸潤;
気管分岐部に達しない
気管分岐部から2 cm未満の主気管支浸潤;
肺全体の無気肺か閉塞性肺炎]のいずれかを伴う
Grossly recognizable multiple tumor nodules of similar histology
in the
same lobe are to be categorized as pT3.
pT4: [縦隔, 心臓、大血管、気管、反回神経、食道、
椎体、気管分岐部]のいずれかへの浸潤 or
同側肺の異なる葉に独立した腫瘍結節
Multiple tumor nodule(s) of similar histology in ipsilateral
separate
lobes are to be categorized as pT4.
If separate tumors that are of similar histology in different
segments,
lobes, or lungs show an origin from carcinoma in situ,
no carcinoma in
lymphatics common to both tumors, and
no extrapulmonary metastases at
the time of diagnosis,
they should be categorized as synchronous
primary carcinomas
and staged independently.
Angiolymphatic invasion does not change the pT and
pN classifications
or the TNM stage grouping.
Lymphovascular invasion by tumor may
represent
an unfavorable prognostic finding.
pN1: 同側気管支周囲, 肺門, 肺内, 直接浸潤含む
(Station #10-hilar, #11s, #11i-interlobar,
#12-lobar, #13-segmental, #14-subsegmental)
pN2: 同側縦隔, 気管支分岐部下 (Station 2-9)
#2, upper paratracheal; #3, prevascular/retrotracheal
#4, lower paratracheal; #5, subaortic; #6, paraaortic
#7, subcarinal; #8, paraesophageal; #9, pulmonary lig.
pN3: 対側縦隔, 肺門, 同側の斜角筋, 鎖骨上窩(#1)
ITCは0.2 mm以下の腫瘍塊で、見つけてもN0, M0とする。
pN0(i-) ITCなし; pN0(i+) ITCあり
pN0(mol-) 形態以外でもITCなし; pN0(mol+):
形態以外でITCあり。
pM1a: 対側肺の独立した腫瘍;
胸膜結節; 悪性胸水/心嚢水
pM1b: 胸腔外転移
接頭辞: 該当すればm(多発), r(再発), y(治療後)を前につける
Stage 0, pTis
Stage IA, pT1
Stage IB, pT2a
Stage IIA, pT1ab2aN1 or T2b
Stage IIB, pT2bN1 or pT3
Stage IIIA, T12N2 or T3N12 or T4N01
Stage IIIB, N3 or T4N2
Stage IV, M
リンパ節名称 (R, Lで左右区別)
#1 鎖骨上窩
#2 上部気管傍リンパ節 (#2R, #2L)
#3 血管前・気管後リンパ節 (#3a血管前リンパ節, #3p気管後リンパ節)
#4
下部気管傍リンパ節 (#4R, #4L)
#5 大動脈下リンパ節
#6 大動脈傍リンパ節
#7 気管分岐下リンパ節
#8 食道傍リンパ節
#9 肺靱帯リンパ節
N1リンパ節
#10 主気管支周囲リンパ節
#11 葉気管支間リンパ節 (#11s, #11i)
#12 葉気管支周囲リンパ節
#13 区域気管支周囲リンパ節
#14 亜区域気管支周囲リンパ節
リンパ節の命名に迷った時は，小さい番号のリンパ節名を選ぶ (!?)
---
附：肺の上皮性腫瘍
Bronchial papillomas
Sclerosing pneumocytoma
Alveolar adenoma
Papillary adenoma of the lung
Bronchiolar adenoma / ciliated muconodular papillary tumour
Mucinous cystadenoma of the lung
Mucous gland adenoma of the lung
Atypical adenomatous hyperplasia of the lung
Adenocarcinoma in situ of the lung
Minimally invasive adenocarcinoma of the lung
Invasive non-mucinous adenocarcinoma of the lung
Invasive mucinous adenocarcinoma of the lung
Colloid adenocarcinoma of the lung
Fetal adenocarcinoma of the lung
Enteric-type adenocarcinoma of the lung
Squamous dysplasia and carcinoma in situ of the lung
Squamous cell carcinoma of the lung
Lymphoepithelial carcinoma of the lung
Large cell carcinoma of the lung
Adenosquamous carcinoma of the lung
Pleomorphic carcinoma of the lung
Pulmonary blastoma
Carcinosarcoma of the lung
NUT carcinoma of the lung (see NUT carcinoma of the thorax)
Thoracic SMARCA4-deficient undifferentiated tumour
Pleomorphic adenoma of the lung
Adenoid cystic carcinoma of the lung
Epithelial-myoepithelial carcinoma of the lung
Mucoepidermoid carcinoma of the lung
Hyalinizing clear cell carcinoma of the lung
Myoepithelioma and myoepithelial carcinoma of the lung
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia
Carcinoid/neuroendocrine tumour of the lung
Small cell lung carcinoma
Large cell neuroendocrine carcinoma of the lung