Professor and Chairman, UTHSC Gerwin Chair for Cancer Research, Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN.
Medical Director, Cancer Data Services, Levine Cancer Institute, Charlotte, NC.
CA Cancer J Clin. 2017 Mar;67(2):93-99. doi: 10.3322/caac.21388. Epub 2017 Jan 17.
The American Joint Committee on Cancer (AJCC) staging manual has become the benchmark for classifying patients with cancer, defining prognosis, and determining the best treatment approaches. Many view the primary role of the tumor, lymph node, metastasis (TNM) system as that of a standardized classification system for evaluating cancer at a population level in terms of the extent of disease, both at initial presentation and after surgical treatment, and the overall impact of improvements in cancer treatment. The rapid evolution of knowledge in cancer biology and the discovery and validation of biologic factors that predict cancer outcome and response to treatment with better accuracy have led some cancer experts to question the utility of a TNM-based approach in clinical care at an individualized patient level. In the Eighth Edition of the AJCC Cancer Staging Manual, the goal of including relevant, nonanatomic (including molecular) factors has been foremost, although changes are made only when there is strong evidence for inclusion. The editorial board viewed this iteration as a proactive effort to continue to build the important bridge from a "population-based" to a more "personalized" approach to patient classification, one that forms the conceptual framework and foundation of cancer staging in the era of precision molecular oncology. The AJCC promulgates best staging practices through each new edition in an effort to provide cancer care providers with a powerful, knowledge-based resource for the battle against cancer. In this commentary, the authors highlight the overall organizational and structural changes as well as "what's new" in the Eighth Edition. It is hoped that this information will provide the reader with a better understanding of the rationale behind the aggregate proposed changes and the exciting developments in the upcoming edition. CA Cancer J Clin 2017;67:93-99. © 2017 American Cancer Society.
美国癌症联合委员会(AJCC)分期手册已成为癌症患者分类、定义预后和确定最佳治疗方法的基准。许多人认为肿瘤、淋巴结、转移(TNM)系统的主要作用是作为一种标准化的分类系统,用于评估人群中癌症的严重程度,包括初始表现和手术后,以及癌症治疗的总体影响。癌症生物学知识的快速发展,以及预测癌症结果和治疗反应的生物因素的发现和验证,提高了准确性,这使得一些癌症专家对基于 TNM 的方法在个体化患者层面的临床护理中的实用性提出了质疑。在 AJCC 癌症分期手册第八版中,纳入相关非解剖学(包括分子)因素的目标是首要的,尽管只有在有强有力的纳入证据时才会进行更改。编辑委员会认为,这一迭代是一种积极主动的努力,继续从“基于人群”的方法向更“个性化”的患者分类方法建立重要桥梁,这是精准分子肿瘤学时代癌症分期的概念框架和基础。AJCC 通过每一个新版本来推广最佳分期实践,为癌症护理提供者提供对抗癌症的强大、基于知识的资源。在这篇评论中,作者强调了第八版的总体组织和结构变化以及“新内容”。希望这些信息能使读者更好地理解总提案变更背后的原理以及即将发布的版本中的令人兴奋的发展。CA Cancer J Clin 2017;67:93-99. © 2017 美国癌症协会。