MD  >> Vol. 7 No. 3 (September 2017)

    Application of “Therapeutic Stages (ZL)” under the Precise Treatment of Gynecological Malignant Tumor Diagnosis and Treatment

  • 全文下载: PDF(362KB) HTML   XML   PP.73-78   DOI: 10.12677/MD.2017.73012  
  • 下载量: 335  浏览量: 681  


陈志辽,张睿:中山大学孙逸仙纪念医院妇产科,广东 广州

治疗性分期(ZL)精准治疗妇科恶性肿瘤Therapeutic Stages (ZL) Precise Treatment Gynecological Malignant Tumor


分期是现代肿瘤治疗的核心内容,是临床治疗的约定规则,其实无论哪种分期都有局限性和缺点,临床医生的任务是决定最有效的治疗过程和做出预后判断。肿瘤分期/评分的意义在于:1) 指导治疗方案的选择;2) 提供预后信息;3) 评价治疗效果;4) 利于同行信息交换与沟通;5) 促进肿瘤研究。不恰当的分期,会导致临床诊疗无效的严重后果。TNM分期系统是目前国际上最为通用的分期系统,它的基本原则,分为T、N和M。TNM分类和分期体系一旦确定,就必须在医疗记录上保持不变。治疗性分期(ZL)必需以治疗方法为基础,不同治疗方法有不同分期。对靶向治疗敏感,应该是早期易治肿瘤,而不是晚期的患者。ZL分期有以下特点:1) 不可能用肿瘤体积大小的TMN分期;2) 必须包含治疗效果的内容,例如临床获得指标减小1/4。癌症并非静态的、整体性的疾病,随着研究的深入,癌症异质性逐渐被发觉,人们逐渐认识到每个癌症患者可能有不同的起源,即便是同种类型的肿瘤患者也是如此。目前,我们对待癌症的诊断和开发抗癌疗法都依赖TNM分期,将疾病的治疗当作一个整体的解剖。随着临床经验积累,我们将肿瘤治疗的目光放在肿瘤异质性上,采用与精准治疗相适应的ZL分期,开启肿瘤诊疗的新旅程。

Staging is the core content of modern cancer treatment, the provision of the rules of clinical treatment. In fact, no matter what kind of installment, it has limitations and shortcomings. The clinical doctor’s task is to determine the most effective treatment process and make prognosis judgment. Tumor staging/scoring significance lies in: 1) To guide the choice of treatment; 2) Pro-vides prognostic information; 3) Evaluate the effect of the treatment; 4) To peer information ex-change and communication; 5) Promotes cancer research. Improper installment, will cause serious consequences of clinical diagnosis and treatment is invalid. TNM Staging System is the most common international staging system, its basic principle is divided into T, N and M. Once estab-lished, TNM classification and staging system must remain the same in the medical records. The-rapeutic Stages (ZL) required on the basis of treatment, different treatment methods have different stages. Sensitive to targeted therapy, cancer should be easy to cure, early rather than late. ZL installment has the following characteristics: 1) Impossibly use TMN stages of tumor size; 2) Must include the content of the therapeutic effect, such as clinical indicators reduce 1/4. Cancer is not a static, integrated disease, with the deepening of the research, the heterogeneity of cancer is dis-covered gradually, people get to know each cancer patient may have different origin, even cancer patients of the same type. At present, diagnosis of cancer and development of anticancer therapy depend on the TNM staging, we treat the treatment of diseases as a whole anatomy. As the accu-mulation of clinical experience, we focus tumor therapy on tumor heterogeneity, use ZL matched with precise treatment, open the new journey of tumor diagnosis and treatment.

陈志辽, 张睿. “治疗性分期(ZL)”在精准治疗下的妇科恶性肿瘤诊疗的应用[J]. 医学诊断, 2017, 7(3): 73-78.


[1] Kolomainen, D.F., Larkin, J.M., Badran, M., et al. (2002) Epithelial Ovarian Cancer Metastasizing to the Brain: A Late Manifestation of the Disease with an Increasing Incidence. Journal of Clinical Oncology, 20, 982-986.
[2] Micha, J.P., Goldstein, B.H., Hunter, J.V., et al. (2004) Long-Term Survival in an Ovarian Cancer Patient with Brain Metastases. Gynecologic Oncology, 92, 978-980.
[3] Siegel, R., Ma, J., Zou, Z. and Jemal, A. (2014) Cancer Statistics, 2014. CA: A Cancer Journal for Clinicians, 64, 103- 105.
[4] Cohen, Z.R., Suki, D., Weinberg, J.S., et al. (2004) Brain Metastases in Patients with Ovarian Carcinoma: Prognostic Factors and Outcome. Journal of Neuro-Oncology, 66, 313-325.
[5] Zahoor, H., Luketich, J.D., Weksler, B., Winger, D.G., Christie, N.A., Levy, R.M., Gibson, M.K., Davison, J.M. and Nason, K.S. (2015) The Revised American Joint Committee on Cancer Staging System (7th edition) Improves Prognostic Stratification after Minimally Invasive Esophagectomy for Esophagogastric Adenocarcinoma. The American Journal of Surgery, 210, 610-617.
[6] Mikami, M., Suzuki, A., Takehara, K., et al. (2003) A Case of Ovarian Cancer with Remote Metastases, with Emphasis on Changes in Tumor Marker Values. Gynecologic Oncology, 90, 462-465.
[7] Tay, S.K. and Rajesh, H. (2005) Brain Metastases from Epithelial Ovarian Cancer. International Journal of Gynecological Cancer, 15, 824-829.