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Article: TNM: Therapeutically Not Mandatory

TitleTNM: Therapeutically Not Mandatory
Authors
KeywordsAdjuvant therapies
Cancer staging
Predictive factors
Prognostic factors
Target-specific drugs
Issue Date2009
PublisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/ejca
Citation
European Journal Of Cancer, 2009, v. 45 n. 7, p. 1111-1116 How to Cite?
AbstractCancer survival may be inversely related to the speed at which a primary tumour grows and disseminates. Assessment of prognosis using surgical and/or radiological definition of disease extent, i.e. staging, has thus become a standard intervention in newly diagnosed patients, with the most popular framework being the tumour-node-metastasis (TNM) system. However, increasing use of biomarkers - non-TNM factors that predict therapeutic benefit, rather than adverse disease outcome - has weakened the decision-making dominance of TNM. This shift from risk-led to benefit-led practice is now starting to blur the time-honoured qualitative distinction between curable (M0, early stage, adjuvant) and incurable (M1, early metastatic, palliative) disease treatment strategies; the same biologic drug strategy may improve average survival outcomes by similar increments for two patients, one of whom is 'adjuvant' and the other 'metastatic'. Plausibly, then, biomarker-positive patients presenting with high-TNM (M1) disease may enjoy the same, if not more, disease-free and/or overall survival benefit as conventional low-TNM (M0) patients when treated with standard adjuvant interventions. Conversely, M0 patients concerned by quality-of-life issues such as alopecia may in future be able to choose better-tolerated personalised drug regimens similar to those now used with survival benefit in palliative settings, even if such adjuvant regimens have not yet been validated by level 1 data. To these ends, a modernised decision-oriented disease staging system called METS (molecular/extra-primary/tumour/symptoms) is presented here. © 2009 Elsevier Ltd. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/59340
ISSN
2015 Impact Factor: 6.163
2015 SCImago Journal Rankings: 3.152
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorEpstein, RJen_HK
dc.date.accessioned2010-05-31T03:48:02Z-
dc.date.available2010-05-31T03:48:02Z-
dc.date.issued2009en_HK
dc.identifier.citationEuropean Journal Of Cancer, 2009, v. 45 n. 7, p. 1111-1116en_HK
dc.identifier.issn0959-8049en_HK
dc.identifier.urihttp://hdl.handle.net/10722/59340-
dc.description.abstractCancer survival may be inversely related to the speed at which a primary tumour grows and disseminates. Assessment of prognosis using surgical and/or radiological definition of disease extent, i.e. staging, has thus become a standard intervention in newly diagnosed patients, with the most popular framework being the tumour-node-metastasis (TNM) system. However, increasing use of biomarkers - non-TNM factors that predict therapeutic benefit, rather than adverse disease outcome - has weakened the decision-making dominance of TNM. This shift from risk-led to benefit-led practice is now starting to blur the time-honoured qualitative distinction between curable (M0, early stage, adjuvant) and incurable (M1, early metastatic, palliative) disease treatment strategies; the same biologic drug strategy may improve average survival outcomes by similar increments for two patients, one of whom is 'adjuvant' and the other 'metastatic'. Plausibly, then, biomarker-positive patients presenting with high-TNM (M1) disease may enjoy the same, if not more, disease-free and/or overall survival benefit as conventional low-TNM (M0) patients when treated with standard adjuvant interventions. Conversely, M0 patients concerned by quality-of-life issues such as alopecia may in future be able to choose better-tolerated personalised drug regimens similar to those now used with survival benefit in palliative settings, even if such adjuvant regimens have not yet been validated by level 1 data. To these ends, a modernised decision-oriented disease staging system called METS (molecular/extra-primary/tumour/symptoms) is presented here. © 2009 Elsevier Ltd. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherPergamon. The Journal's web site is located at http://www.elsevier.com/locate/ejcaen_HK
dc.relation.ispartofEuropean Journal of Canceren_HK
dc.subjectAdjuvant therapiesen_HK
dc.subjectCancer stagingen_HK
dc.subjectPredictive factorsen_HK
dc.subjectPrognostic factorsen_HK
dc.subjectTarget-specific drugsen_HK
dc.titleTNM: Therapeutically Not Mandatoryen_HK
dc.typeArticleen_HK
dc.identifier.emailEpstein, RJ: repstein@hku.hken_HK
dc.identifier.authorityEpstein, RJ=rp00501en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.ejca.2009.02.020en_HK
dc.identifier.pmid19328677-
dc.identifier.scopuseid_2-s2.0-64349121567en_HK
dc.identifier.hkuros162579en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-64349121567&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume45en_HK
dc.identifier.issue7en_HK
dc.identifier.spage1111en_HK
dc.identifier.epage1116en_HK
dc.identifier.isiWOS:000266153600010-
dc.publisher.placeUnited Kingdomen_HK
dc.identifier.scopusauthoridEpstein, RJ=34975074500en_HK

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