Is TNM Staging the Most Relevant Prognostic Clinical Factor to Consider for Treatment Decisions Before and After Surgery?
The tumour nodes metastasis (TNM) system is currently the most utilised staging system to predict outcome and guide the management of patients with rectal cancer. Serial changes to the system have been made over recent years with different versions being used around the world leading to confusion. When determining treatment pathways, multidisciplinary teams (MDT) often take into account various tumour, treatment and patient-related prognostic factors in addition to TNM stage. These additional factors may include tumour type, grade, mismatch repair status, depth of extramural spread, circumferential resection margin status, lymphovascular invasion, tumour budding, tumour cell density, post-treatment regression and plane of surgical excision. This raises the question as to whether a more comprehensive prognostic staging system should be considered rather than the current TNM system.
KeywordsTNM Staging Prognostic factors Rectal cancer
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