a Departments of Surgical Oncology and Cancer Prevention and Control , Roswell Park Comprehensive Cancer Center , Buffalo , NY , USA.
b Department of Breast Medical Oncology, Division of Cancer Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
Expert Rev Anticancer Ther. 2019 Apr;19(4):309-318. doi: 10.1080/14737140.2019.1582335. Epub 2019 Feb 26.
Cancer staging has historically been based solely on the anatomic extent of the tumor (T), spread to lymph nodes (N), and the presence of distant metastases (M). More recently biologic factors have been added to modify TNM stage groups to provide more accurate prognosis for patients. Areas covered: The American Joint Committee on Cancer (AJCC) updated breast cancer staging in 2016 to include T, N, M, tumor grade and expression of estrogen and progesterone receptors and HER2. Addition of these factors changed the stage group for a large fraction of cases compared to prior TNM stage groupings. This updated 'prognostic stage' provides more robust and precise prognosis information. Expert opinion: Inclusion of biological information in staging changes the meaning and the use of stage in clinical practice. This paper reviews the evidence supporting these changes, limitations affecting staging, and discusses the implications for clinical practice and the future of breast cancer staging.
癌症分期历来仅基于肿瘤的解剖范围（T）、淋巴结转移（N）和远处转移（M）。最近，生物学因素已被添加到修改 TNM 分期组中，为患者提供更准确的预后。
美国癌症联合委员会（AJCC）在 2016 年更新了乳腺癌分期，纳入了 T、N、M、肿瘤分级以及雌激素和孕激素受体及 HER2 的表达。与之前的 TNM 分期相比，这些因素的加入改变了很大一部分病例的分期组。这个更新的“预后分期”提供了更强大和精确的预后信息。
分期中生物学信息的纳入改变了分期在临床实践中的意义和用途。本文综述了支持这些变化的证据、影响分期的局限性，并讨论了对临床实践和乳腺癌分期未来的影响。
