口腔颌面头颈肿瘤外科常用TNM分期 (AJCC 8th)

Oral cavity

1. Primary tumor (T)

	Clinical T (cT)
Tx	Primary tumor cannot be assessed
Tis	Carcinoma in situ
T1	Tumor ≤ 2 cm, ≤ 5 mm depth of invasion (DOI)
T2	Tumor ≤ 2 cm, DOI > 5 mm and ≤ 10 mm; or tumor > 2 cm but ≤ 4 cm, and DOI ≤ 10 mm
T3	Tumor > 4 cm; or any tumor with DOI > 10 mm but ≤ 20 mm
T4	Moderately advanced or very advanced local disease
T4a	Moderately advanced local disease: Tumor invades adjacent structures (eg, through cortical bone of the mandible or maxilla, or involves maxillary sinus or skin of the face) or extensive tumor with bilateral tongue involvement and/or DOI > 20 mm. Note: Superficial erosion of bone/tooth socket (alone) by a gingival primary is not sufficient to classify a tumor as T4.
T4b	Very advanced local disease: Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery

2. Regional lymph nodes (N)

	Clinical N (cN)
Nx	Regional nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and no extranodal extension (ENE [-])
N2	Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a	Metastasis in a single ipsilateral lymph node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c	Metastasis in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N3	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or metastasis in any node(s) and clinically overt ENE (+)
N3a	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b	Metastasis in any node(s) and clinically overt ENE (+)

	Pathological N (pN)
Nx	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in a single ipsilateral lymph node ≤ 3 cm in greatest dimension and ENE (-)
N2	Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or > 3 cm but not more than 6 cm in greatest dimension and ENE (-); or metastases in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-); or in bilateral or contralateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2a	Metastasis in a single ipsilateral lymph node, 3 cm or smaller in greatest dimension and ENE (+); or a single ipsilateral node > 3 cm but not more than 6 cm in greatest dimension and ENE (-)
N2b	Metastasis in multiple ipsilateral lymph nodes, none > 6 cm in greatest dimension and ENE (-)
N2c	Metastasis in bilateral or contralateral lymph node(s), none > 6 cm in greatest dimension and ENE (-)
N3	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-); or in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+)
N3a	Metastasis in a lymph node > 6 cm in greatest dimension and ENE (-)
N3b	Metastasis in a single ipsilateral node > 3 cm in greatest dimension and ENE (+); or multiple ipsilateral, contralateral, or bilateral nodes, any with ENE (+); or a single contralateral node of any size and ENE (+)

3. Distant metastasis (M)

M classification	Description
cM0	No distant metastasis
cM1	Distant metastasis
pM1	Distant metastasis, microscopically confirmed

4. Histologic grade (G)

G classification	Description
Gx	Grade cannot be assessed
G1	Well differentiated
G2	Moderately differentiated
G3	Poorly differentiated

5. Anatomic stage/prognostic groups

Stage	TNM
0	TisN0M0
I	T1N0M0
II	T2N0M0
III	T3N0M0; T1-3N0M0
IVA	T4aN0-1M0; T1-4aN2M0
IVB	TanyN3M0; T4bNanyM0
IVC	TanyNanyM1