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Evidence‐based medicine: the time has come to set standards for staging
Author(s) -
Quirke Phil,
Cuvelier Claude,
Ensari Arzu,
Glimelius Bengt,
Laurberg Søren,
Ortiz Hector,
Piard Francoise,
Punt Cornelis JA,
Glenthoj Anders,
Pennickx Freddy,
Seymour Matt,
Valentini Vincenzo,
Williams Geraint,
Nagtegaal Iris D
Publication year - 2010
Publication title -
the journal of pathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.964
H-Index - 184
eISSN - 1096-9896
pISSN - 0022-3417
DOI - 10.1002/path.2720
Subject(s) - appeal , medicine , reputation , stage (stratigraphy) , set (abstract data type) , subject (documents) , process (computing) , test (biology) , evidence based medicine , intensive care medicine , computer science , political science , alternative medicine , law , pathology , paleontology , library science , biology , programming language , operating system
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. Copyright © 2010 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.