Rami-Porta Ramón
Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Plaza Dr. Robert 5, 08221 Terrassa, Spain.
Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, 08221 Terrassa, Spain.
Cancers (Basel). 2021 Apr 17;13(8):1940. doi: 10.3390/cancers13081940.
Since its conception by Pierre Denoix in the mid-20th century, the tumor, node, and metastasis (TNM) classification has undergone seven revisions. The North American database managed by Clifton Mountain was used to inform the 2nd to the 6th editions, and an international database collected by the International Association for the Study of Lung Cancer, promoted by Peter Goldstraw, was used to inform the 7th and the 8th editions. In these two latest editions, it was evident that the impact of tumor size was much greater than it was suggested in previous editions; that the amount of nodal disease had prognostic relevance; and that the number and location of the distant metastases had prognostic implications. However, the TNM classification is not the only prognostic factor. Data are being collected now to inform the 9th edition of the TNM classification, scheduled for publication in 2024. Patient-, environment-, and tumor-related factors, including biomarkers (genetic biomarkers, copy number alterations, and protein alterations) are being collected to combine them in prognostic groups to enhance the prognosis provided by the mere anatomic extent of the tumor, and to offer a more personalized prognosis to an individual patient. International collaboration is essential to build a large and detailed database to achieve these objectives.
自20世纪中叶皮埃尔·德诺瓦提出肿瘤、淋巴结和转移（TNM）分类以来，该分类已历经七次修订。由克利夫顿·芒廷管理的北美数据库为第2版至第6版的修订提供了依据，由彼得·戈德斯通推动的国际肺癌研究协会收集的国际数据库则为第7版和第8版的修订提供了依据。在这两个最新版本中，很明显肿瘤大小的影响比前几版所显示的要大得多；淋巴结疾病的数量具有预后相关性；远处转移的数量和位置也具有预后意义。然而，TNM分类并非唯一的预后因素。目前正在收集数据，为定于2024年出版的第9版TNM分类提供依据。正在收集患者、环境和肿瘤相关因素，包括生物标志物（基因生物标志物、拷贝数改变和蛋白质改变），以便将它们组合成预后组，以改善仅根据肿瘤解剖范围所提供的预后，并为个体患者提供更个性化的预后。国际合作对于建立一个庞大而详细的数据库以实现这些目标至关重要。
