Clinical symptoms and comorbidity: significance for the prognostic classification of cancer

作者：Jay F. Piccirillo, Alvan R. Feinstein · 发表于：Cancer · 年份：1996 · DOI：10.1002/(sici)1097-0142(19960301)77:5<834::aid-cncr5>3.0.co;2-e · 被引用次数：238 · 研究领域：Breast Cancer Treatment Studies、Cancer Cells and Metastasis、Radiomics and Machine Learning in Medical Imaging

BACKGROUND: In 1992, the Cancer Registries Amendment Act allotted 30 million dollars annually for five years to establish a national program of cancer registries. Because the cornerstone of cancer staging is the Tumor, Node, Metastasis (TNM) system, this article is devoted to a brief history of the system, to important concepts of clinical biology that should be included in classification systems for cancer, and to sources and potential solutions for current problems. METHODS: A qualitative review of published literature on cancer staging, prognosis, and treatment effectiveness was performed, notes from previous American Joint Committee on Cancer (AJCC) meetings were reviewed, and a discussion with a former AJCC member was completed. RESULTS: Despite an excellent description of a tumor's size and extent of anatomic spread, the TNM system does not alone account for the cancer's clinical biology which is manifested by both the structural form of a tumor its physiological function in a patient. Important prognostic information can be determined by a patient's symptoms, which reflect some of a tumor's biologic behavior, and by comorbidity that is not a feature of the cancer itself. Five reasons were identified for the adherence to a strictly morphologic staging system. CONCLUSIONS: Widespread use of the TNM system during the past 30 years has unquestionably helped to standardize the classification of cancer and to improve prognostic estimates. Nevertheless, the estimates remain r...