Peabody T D, Simon M A
University of Chicago Medical Center, Section of Orthopaedic Surgery and Rehabilitation Medicine, Illinois.
Clin Orthop Relat Res. 1993 Apr(289):19-31.
The TNM staging system is a modus for diagnosis and treatment in which T is the extent of the tumor involvement, N is lymph node involvement, and M is the metastases; this system is supplemented with a histologic malignancy grade. Staging systems identify specific prognostic factors with which to predict clinical outcome. Staging systems are useful for assigning treatment priorities, determining the role of adjuvant therapies, and evaluating clinical investigations. Unfortunately, no universally accepted staging system for soft-tissue sarcomas exists. This is related to the relatively low incidence of sarcomas, the unique and unpredictable behavior of sarcomas, significant disagreement regarding histogenesis and grading, and lack of consensus regarding the value of various prognostic factors. In adults, the two most commonly used staging systems are those developed by the American Joint Committee on Cancer and by Enneking. In children, the Intergroup Rhabdomyosarcoma Study and the International Union Against Cancer have described the systems most commonly used. These systems for soft-tissue sarcomas rely on an ability to accurately determine both the local and distant extent of disease. Advances in the field of computed tomography and magnetic resonance imaging have made this possible. It is likely that a staging system based upon a more sophisticated understanding of the basic biology of sarcomas will become available.
TNM分期系统是一种用于诊断和治疗的方法，其中T代表肿瘤累及范围，N代表淋巴结受累情况，M代表转移情况；该系统还补充了组织学恶性程度分级。分期系统可识别特定的预后因素，用以预测临床结果。分期系统有助于确定治疗优先级、明确辅助治疗的作用以及评估临床研究。不幸的是，目前尚无被普遍接受的软组织肉瘤分期系统。这与肉瘤相对较低的发病率、肉瘤独特且不可预测的行为、关于组织发生和分级的重大分歧以及对各种预后因素价值缺乏共识有关。在成人中，最常用的两种分期系统是由美国癌症联合委员会和恩内金制定的。在儿童中，横纹肌肉瘤协作组研究和国际抗癌联盟描述了最常用的系统。这些软组织肉瘤分期系统依赖于准确确定疾病局部和远处范围的能力。计算机断层扫描和磁共振成像领域的进展使这成为可能。基于对肉瘤基本生物学更深入理解的分期系统有望问世。
