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G.

PENETUAN STADIUM KANKER PARU


Penggolongan (stadium) karsinoma dilakukan berdasarkan :
1.

Ukuran tumor (T = tumour)

2.

Penyebaran kelenjar getah bening didekatnya (N = Node)

3.

Penyebaran ke organ lain (M = Metastasis)

Sistem Stadium TNM Internasional untuk kanker paru yang sudah direvisi: 1997 American
Joint Committee on cancer
Gambaran TNM

DEFINISI

STATUS TUMOR PRIMER


T0

Tidak terbukti adanya tumor primer

Tx

Ca yg tersembunyi terlihat pada sitologi bilasan bronkus, tetapi tidak terlihat pada
radiogram atau bronkoskopi

Tis

Ca in situ (ditemukan sel tumor di suatu tempat & belum menyebar)

T1

Tumor berdiameter 3 cm dikelilingi paru atau pleura viseralis yg normal

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

KETERLIBATAN KGB REGIONAL (N)


N0
Tidak dapat terlihat metastasis pd KGB regional
N1
Metastasis pd peribronkial dan/atau kelenjar2 hilus ipsilateral
N2
Metastasis pd mediastinal ipsilateral atau KGB subkarina
N3
Metastasis pd mediastinal atau KGB hilus kontralateral; KGB
skalenus atau supraklavikular ipsilateral atau kontralateral
METASTASIS JAUH (M)
M0
Tidak diketahui adanya metastasis jauh

M1

Metastasis jauh terdapat pd tempat tertentu (missal otak)

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)

Tx : malignant cells on cytology but no tumour found on bronchoscopy or imaging.

Tis : carcinoma in situ

T1 :

T1a : smaller than 2cm in longest dimension

T1b : larger than 2cm but smaller or equal to 3cm

T2 : > 3cm and > 2cm from carina ; visceral pleura involvement ; lobar atelectasis
o

T2a : larger than 3cm but smaller than 5cm

T2b : larger than 5cm but smaller than 7cm

T3 : < 2cm from carina but not involving trachea or carina ; involvement of chest
wall, diaphragm, mediastinal pleura or parietal pericardium

T4 :
o

involvement of the trachea, oesophagus, vertebra, great vessels or heart

separate tumour nodules in the same lung but not in the same lobe

Nodal status (N)

Nx : regional nodes cannot be assessed

N0 : no regional nodal metastases

N1 : ipsilateral peribronchial, hilar or intrapulmonary nodes

N2 : ipsilateral mediastinal or subcarinal nodes

N3 : contralateral nodal involvement ; ipsilateral or contralateral scalene or


supraclavicular nodal involvement

Distant metastasis (M)

Mx : distant metastases cannot be assessed

M0 : no distant metastases

M1 : distant metastases present


o

M1a : presence of a malignant pleural effusion, pleural dissemination, or


pericardial disease, intra thoracic matastases

M1b : extra-thoracic matastases

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.

Sistem staging juga mengalami revisi sebagaimana dijelaskan pada Tabel 3.


Tabel 3. Revisions to Stage Groupings in the Seventh Edition of the TNM Classification for Lung
Tumors 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)

Five-Year Survival Rate


(%)

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