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美国癌症联合委员会(AJCC)第8版癌症分期系统将于2018-01-01在全球启动执行。在该版分期中,关于肝门部胆管癌的T分期和N分期以及系统分期均较前版有较大的改动。主要更新为:将BismuthⅣ型从T4分期中剔除,N分期以区域淋巴结转移数目进行分期(N1为1~3枚区域淋巴结转移,N2为≥4枚区域淋巴结转移),以及在系统分期中下调T分期,上调N分期(T4从ⅣA期调整为ⅢB期,N1从ⅢB期调整为ⅢC期,N2划分为ⅣA期)。以上更新体现了目前外科治疗对于肝门部胆管癌的进步及局限。一方面,外科手术技术的提高已经可以使T4期病人获得根治性手术切除的机会;另一方面,对于淋巴结转移病人,单靠外科手术已无法进一步提高疗效。借助多学科参与、综合诊疗的模式可能是提高肝门部胆管癌淋巴结转移疗效的一种途径。
The AJCC Phase 8 Cancer Staging System will be launched globally on 2018-01-01. In this version of the stage, about the hilar cholangiocarcinoma T stage and N stage and the system staging are more major changes than the previous version. The main updates were: Bismuth Ⅳ type was removed from the T4 staging, N staging in the number of regional lymph node metastasis (N1 is 1 to 3 regional lymph node metastasis, N2 ≥ 4 regional lymph node metastasis), and in the system staging down T Staging, up-stage N staging (T4 from Ⅳ A to Ⅲ B, N1 from Ⅲ B to Ⅲ C and N2 to IVA). The above update reflects the current surgical treatment of hilar cholangiocarcinoma progress and limitations. On the one hand, advances in surgical techniques have made it possible for patients with stage T4 to have a radical surgical resection. On the other hand, surgery alone can not improve the outcome of patients with lymph node metastases. With multidisciplinary participation, comprehensive diagnosis and treatment model may be to improve hilar cholangiocarcinoma lymph node metastasis of a way.