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AJCC - 版本历史
2026-04-18T11:00:29Z
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2026-01-15T07:56:04Z
<p>建立内容为“<div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff…”的新页面</p>
<p><b>新页面</b></p><div><div style="padding: 0 4%; line-height: 1.8; color: #1e293b; font-family: 'Helvetica Neue', Helvetica, 'PingFang SC', Arial, sans-serif; background-color: #ffffff; max-width: 1200px; margin: auto;"><br />
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<strong>[[AJCC]]</strong>（<strong>[[American Joint Committee on Cancer]]</strong>，<strong>[[美国癌症联合委员会]]</strong>）是制定全球恶性肿瘤分期标准的权威机构。其制定的<strong>[[TNM分期系统]]</strong>（[[TNM Staging System]]）是目前临床肿瘤学中最广泛应用的肿瘤分层工具。[[AJCC]]分期标准通过评估原发肿瘤的大小与侵犯范围（[[T]]）、区域淋巴结受累情况（[[N]]）以及远端转移（[[M]]）来确定肿瘤的临床阶段。随着[[精准医疗]]的发展，[[AJCC]]已从传统的解剖学分期演进为整合了<strong>[[生物标志物]]</strong>、<strong>[[基因表达谱]]</strong>及[[分子分型]]的综合预后评估系统，为制定个体化治疗方案提供了核心依据。<br />
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<div style="font-size: 1.2em; font-weight: bold; letter-spacing: 1.2px;">[[AJCC]]</div><br />
<div style="font-size: 0.75em; opacity: 0.85; margin-top: 4px;">癌症分期国际标准 · 点击展开</div><br />
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<div style="width: 140px; height: 90px; background-color: #f1f5f9; display: flex; align-items: center; justify-content: center; color: #94a3b8; font-size: 0.8em; padding: 10px; text-align: center;">[[TNM]]分期模型要素图</div><br />
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<div style="font-size: 0.8em; color: #64748b; margin-top: 12px; font-weight: 600;">当前版本：第9版 (Version 9)</div><br />
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<th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0; width: 45%;">核心委员会</th><br />
<td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">AJCC / UICC</td><br />
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<th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">分期基础</th><br />
<td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[TNM系统]]</td><br />
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<th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">覆盖范畴</th><br />
<td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #1e40af;">绝大多数[[实体瘤]]</td><br />
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<th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">关键分子指标</th><br />
<td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[HER2]]/[[PSA]]/[[HPV]]</td><br />
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<th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569; border-bottom: 1px solid #e2e8f0;">主要目的</th><br />
<td style="padding: 8px 12px; border-bottom: 1px solid #e2e8f0; color: #0f172a;">[[预后]]评估与治疗指导</td><br />
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<th style="text-align: left; padding: 8px 12px; background-color: #f1f5f9; color: #475569;">[[ICD-O]]关联</th><br />
<td style="padding: 12px; color: #0f172a;">高度一致</td><br />
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<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">核心原理：TNM三位一体评价体系</h2><br />
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[[AJCC]]分期系统的科学性建立在对肿瘤解剖学负荷的量化评估之上，通过三个核心维度定义病程：<br />
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<li style="margin-bottom: 12px;"><strong>T (Primary Tumor)：</strong>原发肿瘤。评估肿瘤的大小、浸润深度以及对邻近器官的侵犯程度（如[[T1]]至[[T4]]）。</li><br />
<li style="margin-bottom: 12px;"><strong>N (Regional Lymph Nodes)：</strong>区域淋巴结。评估是否存在淋巴结转移及其受累的数量和位置（如[[N0]]至[[N3]]）。</li><br />
<li style="margin-bottom: 12px;"><strong>M (Distant Metastasis)：</strong>远端转移。评估肿瘤是否扩散至原发灶及引流淋巴结以外的远端器官（如[[M0]]或[[M1]]）。</li><br />
<li style="margin-bottom: 12px;"><strong>[[分期组合]] (Stage Grouping)：</strong>通过T、N、M的特定组合，将患者划分为[[I期]]（早期）、[[II期]]/[[III期]]（局部进展期）和[[IV期]]（晚期/转移性）。</li><br />
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<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">通用分期矩阵（以实体瘤为例）</h2><br />
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<th style="padding: 10px; border: 1px solid #cbd5e1; color: #0f172a; width: 20%;">分期级别</th><br />
<th style="padding: 10px; border: 1px solid #cbd5e1; color: #475569;">描述特征</th><br />
<th style="padding: 10px; border: 1px solid #cbd5e1; color: #1e40af;">临床意义</th><br />
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<td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[0期]]</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">[[原位癌]] (Tis)</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">病变局限于上皮层，未突破基底膜。</td><br />
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<td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[I期]]</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">肿瘤较小且局限</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">通常可通过单纯[[手术]]达到临床治愈。</td><br />
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<td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[II/III期]]</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">局部侵犯及淋巴结受累</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">需采取[[新辅助]]或辅助[[放化疗]]等综合治疗。</td><br />
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<td style="padding: 8px; border: 1px solid #cbd5e1; font-weight: 600;">[[IV期]]</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">[[远端转移]] (M1)</td><br />
<td style="padding: 8px; border: 1px solid #cbd5e1;">以[[全身系统性治疗]]（靶向/免疫）为主。</td><br />
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<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">分期策略：解剖与分子的深度融合</h2><br />
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在最新的[[AJCC]]指南演进中，分期策略已不再局限于形态学，而是强调多维数据的整合：<br />
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<li style="margin-bottom: 12px;"><strong>[[临床分期]] (cTNM) 与 [[病理分期]] (pTNM)：</strong>cTNM基于影像学和内镜检查，用于治疗方案的选择；pTNM基于术后大体标本和镜下观察，是评估[[生存率]]的金标准。</li><br />
<li style="margin-bottom: 12px;"><strong>[[生物学特征]]纳入：</strong>例如在[[乳腺癌]]分期中，纳入了[[ER]]/[[PR]]/[[HER2]]状态及[[多基因检测]]（如[[Oncotype DX]]）评分。</li><br />
<li style="margin-bottom: 12px;"><strong>[[HPV]]状态的影响：</strong>在[[头颈部肿瘤]]中，[[HPV相关]]的口咽癌被赋予了独立的分期标准，反映了其独特的生物学行为。</li><br />
<li style="margin-bottom: 12px;"><strong>[[动态演变]]监测：</strong>建议在治疗过程中（尤其是[[新辅助治疗]]后）进行[[再分期]]（[[ycTNM]]/[[ypTNM]]），以评估药物敏感性。</li><br />
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<h2 style="background: #f1f5f9; color: #0f172a; padding: 10px 18px; border-radius: 0 6px 6px 0; font-size: 1.25em; margin-top: 40px; border-left: 6px solid #0f172a; font-weight: bold;">关键相关概念</h2><br />
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<li style="margin-bottom: 8px;"><strong>[[TNM分期]]：</strong>由[[AJCC]]与[[UICC]]联合维护的癌症分期核心标准。</li><br />
<li style="margin-bottom: 8px;"><strong>[[预后因素]]：</strong>除了分期外，影响患者长期存活的指标（如[[分级]]、[[年龄]]）。</li><br />
<li style="margin-bottom: 8px;"><strong>[[原位癌]] (Tis)：</strong>处于[[0期]]的最早期癌症，手术治愈率接近100%。</li><br />
<li style="margin-bottom: 8px;"><strong>[[Version 9]]：</strong>AJCC目前推行的最新分期版本，采用滚动更新模式。</li><br />
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<span style="color: #0f172a; font-weight: bold; font-size: 1.05em; display: inline-block; margin-bottom: 15px;">学术参考文献与权威点评</span><br />
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[1] <strong>Amin MB, et al. (2017).</strong> <em>The Eighth Edition AJCC Cancer Staging Manual: Continuing to build a bridge from a population-based to a more "personalized" approach to oncology staging.</em> <strong>[[CA: A Cancer Journal for Clinicians]]</strong>.[Academic Review]<br><br />
<span style="color: #475569;">[权威点评]：该指南奠定了癌症分期从单纯解剖学向分子特征驱动转型的基础。</span><br />
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[2] <strong>Gershenwald JE, et al. (2024/2025 update).</strong> <em>AJCC Cancer Staging Manual, 9th Edition: Key updates and implementation.</em> <strong>[[American Cancer Society Publications]]</strong>.<br><br />
<span style="color: #475569;">[核心价值]：对第九版分期系统在临床工作流中的集成提供了最新指导证据。</span><br />
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[[AJCC]] 癌症分期生态 · 知识图谱<br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">关联组织</td><br />
<td style="padding: 10px 15px; color: #334155;">[[UICC]]•[[NCCN]]•[[WHO]]•[[College of American Pathologists]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">评估工具</td><br />
<td style="padding: 10px 15px; color: #334155;">[[CT/MRI影像]]•[[PET-CT]]•[[术后病理]]•[[基因检测报告]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">分期类别</td><br />
<td style="padding: 10px 15px; color: #334155;">[[临床分期]]•[[病理分期]]•[[新辅助后分期]]•[[复发分期]]</td><br />
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<td style="width: 85px; background-color: #f8fafc; color: #334155; font-weight: 600; padding: 10px 12px; text-align: right; vertical-align: middle; white-space: nowrap;">前沿方向</td><br />
<td style="padding: 10px 15px; color: #334155;">[[基于ctDNA的分子分期]]•[[AI驱动的自动化分期]]•[[生存率预测诺谟图(Nomogram)]]</td><br />
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223.160.136.36