Comments on the editorial by Ferlito and Rinaldo: “The future of TNM staging system in laryngeal cancer: time for a debate?”

Abstract

In this issue of the European Archives of Oto-Rhino-Laryngology and Head & Neck, Ferlito and Rinaldo discuss the future of the TNM staging system for laryngeal cancer and raise the question: “Time for a debate?” [1]. In fact, there has been a debate regarding the TNM-system for laryngeal cancer for many years [2–5]. The question is not a new one, but it certainly needs a closer look every now and then. Tumour staging is the process of deWning the patient’s position on the time axis of the natural history of the malignant disease when the initial diagnosis is made or at any other given point during the course of the disease. The TNM classiWcation is an anatomically based system of staging and provides a general format used for staging of most solid tumours. It was developed between 1943 and 1952 by Prof Pierre Denoix at Institute Gustave-Roussy, Paris, France [6, 7]. In 1968, the TNM ClassiWcation of Malignant Tumours was Wrst published, and is now in its 6th edition. It describes the anatomic extent of cancer and is based on the hypothesis that the probability of survival and the choice of treatment are related to the anatomical extent of the tumour at the primary site (T), the presence or absence of tumour in regional lymph nodes (N), and the presence or absence of metastasis beyond the regional lymph nodes (M). T is usually divided into 4 major parts (T1 to T4, with a further sub-division into T4a and T4b for laryngeal cancer), expressing increasing size or spread of the primary tumour. N comprises 6 categories for laryngeal cancer (N0, N1, N2a, N2b, N2c, N3) and M involves 2 categories (0 and 1—absence or presence of distant metastasis). A number of sites have subcategories, with 2 subdivisions each for T4 and glottic T1 carcinoma [8]. The continuing objectives of the TNM system are to achieve common consent for adopting a global standard in the classiWcation of anatomical extent of disease. The most important aims have been [3, 8]