Document Detail

Evidence-based medicine: the time has come to set standards for staging.
MedLine Citation:
PMID:  20593493     Owner:  NLM     Status:  MEDLINE    
For international communication in cancer, staging systems such as TNM are essential; however, the principles and processes used to decide about changes in every new edition of TNM need to be subject to debate. Changes with major impact for patient treatment are introduced without evidence. We think that TNM should be a continual reactive process, rather than a proactive process. Changes should only occur after extensive discussion within the community, and before the introduction of any changes these should be tested for reproducibility and compared to the currently used gold standard. TNM should not be used to test hypotheses. It should introduce established facts that are beneficial to predicting patient prognosis. TNM should thus be restructured on a basis equivalent to evidence-based guidelines. The strength of the evidence should be explicitly stated and the evidence base given. It is time for the principles of staging to be widely debated and new principles and processes to be introduced to ensure that we are not in the same situation in the future. The disparity between therapeutic decision making and TNM staging is marked and we would appeal for the radical overhaul of TNM staging to make it fit for the twenty-first century. TNM is central to the management of cancer patients and we must protect and enhance its reputation.
Phil Quirke; Claude Cuvelier; Arzu Ensari; Bengt Glimelius; Søren Laurberg; Hector Ortiz; Francoise Piard; Cornelis J A Punt; Anders Glenthoj; Freddy Pennickx; Matt Seymour; Vincenzo Valentini; Geraint Williams; Iris D Nagtegaal
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of pathology     Volume:  221     ISSN:  1096-9896     ISO Abbreviation:  J. Pathol.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-07     Completed Date:  2010-08-02     Revised Date:  2010-09-30    
Medline Journal Info:
Nlm Unique ID:  0204634     Medline TA:  J Pathol     Country:  England    
Other Details:
Languages:  eng     Pagination:  357-60     Citation Subset:  IM    
Pathology and Tumour Biology, Leeds Institute of Molecular Medicine, St. James's University Hospital, University of Leeds, Leeds, UK.
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MeSH Terms
Colorectal Neoplasms / pathology
Evidence-Based Medicine / methods
Lymphatic Metastasis
Neoplasm Staging / methods,  standards*
Neoplasms / pathology*
Comment In:
J Pathol. 2010 Aug;221(4):361-2   [PMID:  20593484 ]
J Pathol. 2010 Nov;222(3):320-1   [PMID:  20725904 ]

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