Sobin Leslie H
Department of Hepatic and Gastrointestinal Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA.
Semin Surg Oncol. 2003;21(1):3-7. doi: 10.1002/ssu.10014.
The TNM Classification describes the anatomic extent of cancer. TNM's ability to separately classify the individual tumor (T), node (N), and metastasis (M) elements and then group them into stages differs from other cancer staging classifications (e.g., Dukes), which are only concerned with summarized groups. The objectives of the TNM Classification are to aid the clinician in the planning of treatment, give some indication of prognosis, assist in the evaluation of the results of treatment, and facilitate the exchange of information. During the past 50 years, the TNM system has evolved under the influence of advances in diagnosis and treatment. Radiographic imaging (e.g., endoscopic ultrasound for the depth of invasion of esophageal and rectal tumors) has improved the accuracy of the clinical T, N, and M classifications. Advances in treatment have necessitated more detail in some T4 categories. Developments in multimodality therapy have increased the importance of the "y" symbol and the R (residual tumor) classification. New surgical techniques have resulted in the elaboration of the sentinel node (sn) symbol. The use of immunohistochemistry has resulted in the classification of isolated tumor cells and their distinction from micrometastasis. The most important challenge facing users of the TNM Classification is how it should interface with the large number of non-anatomic prognostic factors that are currently in use or under study. As non-anatomic prognostic factors become widely used, the TNM system provides an inviting foundation upon which to build a prognostic classification; however, this carries a risk that the system will be overwhelmed by a variety of prognostic data. An anatomic extent-of-disease classification is needed to aid practitioners in selecting the initial therapeutic approach, stratifying patients for therapeutic studies, evaluating non-anatomic prognostic factors at specific anatomic stages, comparing the weight of non-anatomic factors with extent of disease, and communicating the extent of disease data in a uniform manner. Methods are needed to express the overall prognosis without losing the vital anatomic content of TNM. These methods should be able to integrate multiple prognostic factors, including TNM, while permitting the TNM system to remain intact and distinct. This article discusses examples of such approaches.
TNM分期系统描述了癌症的解剖学范围。TNM能够分别对肿瘤（T）、淋巴结（N）和转移（M）进行分类，然后将它们分组为不同阶段，这与其他癌症分期系统（如Dukes分期）不同，后者只关注汇总的组别。TNM分期系统的目的是帮助临床医生制定治疗计划，提供一些预后指标，协助评估治疗结果，并促进信息交流。在过去的50年里，TNM系统在诊断和治疗进展的影响下不断演变。影像学检查（如用于评估食管和直肠肿瘤浸润深度的内镜超声）提高了临床T、N和M分类的准确性。治疗方面的进展使得某些T4类别需要更详细的划分。多模式治疗的发展增加了“y”符号和R（残留肿瘤）分类的重要性。新的手术技术导致了前哨淋巴结（sn）符号的确立。免疫组织化学的应用使得孤立肿瘤细胞得以分类，并与微转移相区分。TNM分期系统的使用者面临的最重要挑战是，它应如何与目前正在使用或研究的大量非解剖学预后因素相结合。随着非解剖学预后因素的广泛应用，TNM系统为构建预后分类提供了一个诱人的基础；然而，这也带来了一个风险，即该系统可能会被各种预后数据淹没。需要一个疾病解剖学范围分类来帮助从业者选择初始治疗方法，对患者进行治疗研究分层，在特定解剖阶段评估非解剖学预后因素，比较非解剖学因素与疾病范围的权重，并以统一的方式传达疾病范围数据。需要一些方法来表达总体预后，同时又不丢失TNM至关重要的解剖学内容。这些方法应能够整合包括TNM在内的多个预后因素，同时允许TNM系统保持完整和独特。本文讨论了此类方法的示例。
