In a recent Review in The Lancet Oncology, Quirke and colleagues suggest that the Tumour, Nodes, Metastasis (TNM) staging system does not deliver what is needed to provide adequate advice in the 21st century. We agree with the authors. Predicting clinical outcome is an important component of the clinical decision-making process, and the TNM staging system has long been accepted for establishing patient outcomes in malignancies. This system is based on the anatomical extent of carcinoma invasion and metastasis, and its objectives are to provide clinicians with a platform from which to assess the extent of disease, to help in treatment planning, and to predict prognosis. However, this system is based solely on disease-related parameters and does not incorporate non-carcinoma variables, such as concomitant illnesses, which could also affect patient outcome.
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