肺癌的标准治疗，目前已经进入到精准治疗的阶段，手术切除、化疗、放疗、分子靶向治疗、抗血管生成治疗以及免疫治疗，在肺癌中都扮演着极其重要的地位。但是，上述所有的治疗手段，都建立在准确的肺癌 TNM 分期和总分期的基础上进行。
在肿瘤分期中，肺癌的分期是比较复杂的，记忆难度很大。但归纳起来，总还是有一些方法可循的。下面我们就从 T 分期、N 分期、M 分期、临床分期（第八版 TNM 分期）这四个方面分别来谈一谈。
一、什么是肺癌 TNM 分期
国际肺癌研究学会
（International Association for the Study of Lung Cancer, IASLC）
于 2015 年对肺癌分期系统进行了更新，制定了第八版国际肺癌TNM分期标准，其修订稿发表于
《
Journal of Thoracic Oncology
》，新版分期于 2017 年 1 月正式颁布实施。新的分期标准采纳了来自 16 个国家的 35 个数据库，包含了自 1999 年-2010 年间新发病的 94,708 例肺癌病例。第八版新版分期的优势在于能够更好的显示患者的预后，对临床具有更高的指导价值。
TNM 全称为 Tumor Node Metastasis。
Tumor 指肿瘤原发灶的情况，包括肿瘤大小、主支气管距离隆突受累距离、肺 不张的范围、横膈受累情况和纵隔胸膜侵犯；分别用 TX、T0~T4 来表示。
Node 指区域淋巴结（regional lymph node）受累情况。区域淋巴结的评估在 总分期中扮演着极其重要的地位。尤其淋巴结转移站数及是否存在跳跃性转移对预后会 产生重要影响。分别用 NX、N0~N3 表示。
Metastasis 指远处转移，包括，转移器官及转移灶数目，同时第八版纳入了远处寡 转移病灶的评估。分别用 MX、M1a、M1b、M1c 来表示。
当一个临床病例有了 TNM 分期，我们进而可以推断出总分期，也就是
I-IV
期中是具体哪一期。
二、如何快速准确的判断TNM分期
1、T 分期：从大小、位置、浸润范围 3 个维度记忆
肺癌分期中，最复杂的要属 T 分期，它不是单纯的以大小或浸润深度去区分，而要从大小、位置、浸润范围三个维度去界定。满足其中任何一个维度，即可定义为该 T 分期，通常就高不就低。如：肿瘤大小只有 1cm，但位置在主支气管，那么该肿瘤应归为 T2 期。
肿瘤大小
：以 3cm，5cm，7cm 为界，其中 T1 和 T2 又按每 1cm 进行了分割。
肿瘤位置
：1 个结节时，分为 T1a SS（Superficial Spreading，表浅扩散）和 T2 Centr（Central，中央）；同侧 2 个及以上结节时，分为 T3 Satell（Satellite，卫星）和 T4 Ipsi Nod（ipsilateral nodules，同侧结节）。
浸润范围
：分为 T1a (mi)（Minimally Invasive，微浸润），T2 Visc Pl（Visceral Pleura，脏层胸膜），T3 Inv（Invision，浸润）和 T4 Inv。
注：在进行临床分期时，T1a SS、T1a (mi) 与 T1a 一致，T2 Centr、T2 Visc Pl 与 T2a 一致，T3 Satell、T3 Inv 与 T3 一致，T4 Ipsi Nod、T4 Inv 与 T4 一致。
2、N 分期：周围 → 中央 → 对侧
再来看N 分期，肺癌淋巴结共分为 14 站，其中 1～9 站淋巴结（包括锁骨上区淋巴结，上纵隔区淋巴结，主动脉淋巴结，下纵隔区淋巴结）主要位于中央，10～14 站淋巴结主要位于肺周及肺门。
未发生淋巴结转移时，归为 N0。发生淋巴结转移时，若受累淋巴结主要位于肿瘤周围（即同侧 10～14 站），则归为 N1；若受累淋巴结已达中央区域（即 1～9 站），则归为 N2；若受累淋巴结已到达对侧，则归为 N3。
表2：左侧为肺部组织实物模型，右侧为14个标记点名词
3、M 分期：记住一张表即可
三、
临床总分期
怎么根据分期表准确对应清楚自己的分期呢？接下来的这句话很重要，“实际分期反着看”！TNM 分期表进行临床分期时，可采用先 M、再 N、后 T 的方法。
先看 M 分期
—— 若为 M1a 或 M1b，则不需看 T 和 N，直接归为 ⅣA 期；若为 M1c，也不需看 T 和 N，直接归为 ⅣB 期；若为 M0，则需要去看 T 和 N。
再看 N 分期
（M0 情况下） —— 若为 N1，任何 T1 或 T2 均归为 ⅡB 期；任何 T3 或 T4 均归为 ⅢA 期；若为 N2，任何 T1 或 T2 均归为 ⅢA 期；任何 T3 或 T4 均归为 ⅢB 期；若为 N3，任何 T1 或 T2 均归为 ⅢB 期；任何 T3 或 T4 均归为 ⅢC 期；若为 N0，则主要看 T。
最后看 T 分期
（M0、N0 情况下） —— 若为 T1（T1a，T1b，T1c），则归为 ⅠA 期（ⅠA1，ⅠA2，ⅠA3）；若为 T2a，则归为 ⅠB 期；若为 T2b，则归为 ⅡA 期；若为 T3，则归为 ⅡB 期；若为 T4，则归为 ⅢA 期。
注：任何 T1 包括 T1a、T1b、T1c、T1a SS、T1a (mi) ；任何 T2 包括 T2a、T2b、T2 Centr、T2 Visc Pl；任何 T3 包括 T3、T3 Satell、T3 Inv；任何 T4 包括 T4、T4 Ipsi Nod、T4 Inv。
四、分期评估的类型
有了 TNM 分期，临床分期，一个完整的分期书写，还需要一个此次分期评估的前缀类型描述，如下。
总结
肺癌的TNM分期和临床分期经常让临床医师犹如雾里看花，找准上述的关键点和技巧后， 就能快速便捷准确地分期，让临床医师的工作更加事半功倍，得心应手！
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rgba(250, 157, 59, .6);--weui-TAG-BACKGROUND-ORANGE: rgba(250, 157, 59, .1);--weui-TAG-TEXT-GREEN: rgba(6, 174, 86, .6);--weui-TAG-BACKGROUND-GREEN: rgba(6, 174, 86, .1);--weui-TAG-TEXT-BLUE: rgba(16, 174, 255, .6);--weui-TAG-BACKGROUND-BLUE: rgba(16, 174, 255, .1);--weui-TAG-TEXT-BLACK: rgba(255, 255, 255, .5);--weui-TAG-BACKGROUND-BLACK: rgba(255, 255, 255, .05)}}@media screen and (min-width:1024px) and (prefers-color-scheme:dark){body:not(.pages_skin_pc) .wx-root:not([data-weui-theme=light]),body:not(.pages_skin_pc) body:not([data-weui-theme=light]){--weui-BG-0: #111;--weui-BG-1: #1e1e1e;--weui-BG-2: #191919;--weui-BG-3: #202020;--weui-BG-4: #404040;--weui-BG-5: #2c2c2c;--weui-FG-0: rgba(255, 255, 255, .8);--weui-FG-HALF: rgba(255, 255, 255, .6);--weui-FG-1: rgba(255, 255, 255, .5);--weui-FG-2: rgba(255, 255, 255, .3);--weui-FG-3: rgba(255, 255, 255, .1);--weui-FG-4: rgba(255, 255, 255, .15);--weui-FG-5: rgba(255, 255, 255, .1);--weui-RED: #fa5151;--weui-ORANGERED: 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