2.
3.
Sistem Stadium TNM Internasional untuk kanker paru yang sudah direvisi: 1997 American
Joint Committee on cancer
Gambaran TNM
DEFINISI
Tx
Ca yg tersembunyi terlihat pada sitologi bilasan bronkus, tetapi tidak terlihat pada
radiogram atau bronkoskopi
Tis
T1
T2
Tumor berdiameter > 3 cm atau ukuran berapapun yg sudah meyerang pleura viseralis
atau mengakibatkan atelektasi yg meluas ke hilus; harus berjarak 2cm dari karina, tetapi
tidak mengenai karina
T3
Tumor berukuran berapapun dg perluasan langsung pada dinding dada, diafragma, pleura
mediastinalis, atau pericardium tanpa mengenai jantung, pembuluh darah besar, trachea,
esophagus, atau korpus vertebra; atau dalam jarak 2 cm dari karina , tetapi tidak
T4
mengenai karina
Tumor ukuran berapapun invasi ke mediastsinum / terdapat efusi pleura maligna
M1
Karsinoma tersamar TX
N0
Stadium 0
TIS
N0
Stadium I
T1,2
N0
Stadium II
T1,2
N1
Stadium III A
T1-3
N2
Stadium III B
SEMUA T
SEMUA N
Stadium IV
SEMUA T
SEMUA N
Sumber: Price, S.A., Wilson, L.M. (2006)
M0
M0
MO
M0
M0
M0
M1
Pada tahun 2009, International Union Against Cancer dan American Joint Committee on
Cancer menyusun sistem klasifikasi TNM terbaru yang mencakup baik NSCLC, SCLC, dan
karsinoid bronkopulmoner sebagaimana tercantum pada tabel berikut ini :
Primary tumour (T)
T1 :
T2 : > 3cm and > 2cm from carina ; visceral pleura involvement ; lobar atelectasis
o
T3 : < 2cm from carina but not involving trachea or carina ; involvement of chest
wall, diaphragm, mediastinal pleura or parietal pericardium
T4 :
o
separate tumour nodules in the same lung but not in the same lobe
M0 : no distant metastases
Tabel 2: Seventh Edition of the TNM Classification of Lung Cancer Compared With the Sixth
Edition.
Tumor Designation
Prior System
(Sixth
New System
(Seventh Edition)
Five-Year
Survival Rate (%)
Edition)
Size
2 cm
> 2 but 3 cm
> 3 but 5 cm
> 5 but 7 cm
> 7 cm
Pleural or pericardial invasion
Visceral pleura
Parietal pleura
Mediastinal pleura
Parietal pericardium
Central airway invasion
Tumor extending into mainstem
bronchus > 2 cm from carina
Tumor extending into mainstem
bronchus 2 cm from carina
Tumor extending to carina
Lung atelectasis
Tumor causing atelectasis of
less than entire lung
Tumor causing atelectasis of
entire lung
Soft tissue invasion
Chest wall and superior sulcus
Diaphragm
Mediastinum
Heart or great vessels
Trachea
Esophagus
Osseous invasion
Rib
Vertebral body
Nerve invasion
Phrenic nerve
Recurrent laryngeal nerve
Satellite nodules
Same lobe
Same lung, different lobe
Lymph node designation
No lymphadenopathy
Ipsilateral, peripheral, or hilar
interlobar zone involvement
Ipsilateral upper,
aorticopulmonary, lower, or
subcarinal zone involvement
Supraclavicular or
contralateral upper,
aorticopulmonary, lower,
hilarinterlobar, or peripheral
T1
T1
T2
T2
T2
T1aa
T1ba
T2aa
T2ba
T3a
77d
71d
58d
49d
35d
T2
T3
T3
T3
T2ab or T2bC
T3
T3
T3
NAe
NAe
NAe
NAe
T2
T2ab or T2bC
NAe
T3
T3
NAe
T4
T4
NAe
T2
T2ab or T2bC
NAe
T3
T3
NAe
T3
T3
T4
T4
T4
T4
T3
T3
T4
T4
T4
T4
NAe
NAe
NAe
NAe
NAe
NAe
T3
T4
T3
T4
NAe
NAe
T3
T4
T3
T4
NAe
NAe
T4
M1
T3
T4
N0
N1
N0
N1
28f
22f
56g
38g
22g
N2
N2
6g
N3
3h
2h
N3
1h
zone involvement
Metastatic disease designation
Contralateral lung metastases
Pleural or pericardial
dissemination
Distant metastases
M1
T4
M1a
M1a
M1
M1b
NoteCells in bold indicate a change in the designation from the sixth edition. NA indicates not
applicable.
a
T designation is listed for tumors completely surrounded by lung. Designation can increase
depending on presence and extent of invasion.
b
T2a designation if tumor measures 5 cm in long-axis diameter.
c
T2b designation if tumor measures > 5 cm but 7 cm in long-axis diameter.
d
Survival based on patients staged pathologically with complete resection of tumor (R0) and no nodal
or extranodal metastatic disease (N0M0).
e
Individual survival statistics not calculated due to limited information. As a group, 5-year survival
rate in patients pathologically staged with a T3 and T4 designation
(excluding those with tumors > 7 cm or satellite nodules), any R, any N, and M0 was 31% and 22%,
respectively.
f
Survival based on patients staged pathologically with complete or incomplete resection of tumor
(any R), any nodal disease (any N), and M0.
g
Survival based on patients staged pathologically with any tumor designation (any T) and M0.
h
Survival based on patients staged clinically with any T and any N.
Seventh Edition of the TNM Classification of Lung Cancer Compared With the Sixth Edition.
Stage in
Seventh
Edition
T1a
Stage in
Sixth
Edition
T1
N0
N1
N2
N3
IA
II A
III A
III B
T1b
T1
IA
II A
III A
III B
T2a
T2
IB
II A (II B)
III A
III B
T2b
T2
II A
II B
III A
III B
T3 (> 7 cm)
T2
II B (I B)
III A (II B)
III A
III B
T3 (invasion)
T3
II B
III A
III A
III B
T3 (satellite
T4
III B (III A)
III A (III B)
III A (III B)
III B
T4 (invasion)
T4
III A (III B)
III A (III B)
III B
III B
T4 (ipsilateral
M1
III A (IV)
III A (IV)
III B (IV)
III B (IV)
nodule, same
lobe)
nodule,
different lobe)
M1a (pleural
T4
IV (III B)
IV (III B)
IV (III B)
IV (III B)
M1
IV
IV
IV
IV
M1
IV
IV
IV
IV
or pericardial
dissemination
) M1a
(contralateral
lung nodules)
M1b (distant
metastatic
disease)
NoteCells in bold indicate a change in the stage from the sixth edition. Adjacent
stage in parentheses represents staging from the sixth edition.
Tabel 2. Revisions to Stage Groupings in the Seventh Edition of the TNM Classification for Lung
Tumors Compared With the Sixth Edition.
I.
PROGNOSIS
Prognosis secara keseluruhan bagi pasien-pasien dengan karsinoma paru adalah buruk
dan hanya sedikit meningkat dalam beberapa tahun terakhir ini, meskipun telah
diperkenalkan berbagai agen-agen kemoterapi yang baru.
Berikut ini gambaran prognosis dengan menggunakan klasifikasi TNM terbaru :
Tabel 4. Prognostic Factors of Survival in Pathologically Staged Patients With NonSmall Cell Lung
Carcinoma.
Factor
TNM stage
IA
IB
IIA
IIB
IIIA
Cell type
Bronchoalveolar carcinoma
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Adenosquamous carcinoma
Sex
Female
Male
Age (y)
< 70
70
Median Survival
(mo)
95
75
44
29
19
66
56
43
35
23
83
45
44
34
26
61
44
43
41
29
66
40
52
41
49
38
46
38