In this era of multidisciplinary management of the patient with cancer, there is a critical need for accurate information related to the patient, tumor characteristics, and treatment received or planned to facilitate the quality of care delivered. Staging has been a core component of cancer care for decades, and the rapidly evolving pace of oncology calls for measures to improve the quality of cancer staging. The Institute of Medicine report on improving the quality of cancer care noted that “in order to continue to advance the high-quality cancer care delivery system, measurement and assessment of progress in improving the delivery of cancer care, public reporting of information gathered, and development of innovative strategies to facilitate performance improvement will be needed.” This charge from the Institute of Medicine calls for adherence to existing quality indicators (QIs) or measures (QMs), practice guidelines, and the creation of new QIs or QMs when none exist. The American Joint Committee on Cancer (AJCC) is engaged in several efforts to improve the quality of cancer staging. QIs are well-defined, quantifiable targets that allow for the assessment of structure, process, and outcome with regard to care. QIs must be measurable, actionable, and based on evidence. In addition, QIs should serve as benchmarks for the comparison of different metrics associated with care across many institutions. Among several important QIs and QMs for the care of the patient with cancer, accurate and complete documentation of cancer stage has critical implications for the patient, clinician, and public health scientists. Clinicians involved in the care of the patient with cancer, cancer registries, and other users of staging data look to the AJCC to formulate and revise the rules for cancer staging in the United States. Established in 1959, the AJCC has been collaborating with the Union for International Cancer Control since 1982 to provide a unified anatomic staging system for cancer worldwide. Updates to the staging system are performed periodically by convening the best expertise in the field and using the highest available level of evidence. Previous editions of the AJCC staging system have included nonanatomic prognostic factors within the TNM framework for some disease sites. Expansion of staging to include widely accepted pertinent prognostic factors for many other disease sites is also currently under consideration in the ongoing efforts to develop the 8th edition of the AJCC staging system. Accurate staging allows the clinician to offer patients treatment recommendations based on practice guidelines and to discuss prognosis. Cancer stage also serves as an important inclusion, exclusion, and/or stratification criterion for clinical trials. In addition to other variables, data elements with which to derive disease stage are abstracted into the National Cancer Data Base (NCDB), the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, and the Center for Disease Control’s (CDC’s) National Program of Cancer Registries (NPCR). These data elements allow for research into disease outcomes and trends over time based on stage of disease when necessary and are informative in the formulation of guidelines, targeted population cancer control efforts, and allocation of resources. Importantly, staging facilitates national and international collaborative cancer research efforts, and allows clinicians from different cultural and language backgrounds to communicate and share data regarding cancer. This is especially important as the global burden of cancer cases continues to rise, especially in lowincome and middle-income countries. Despite the fundamental role of cancer staging, timely and accurate stage assignment with appropriate documentation can be difficult to achieve in practice. First, ambiguities in portions of the AJCC staging manual leave interpretation of staging rules to the clinician or registrar, either of whom may be incorrect. Critical to improving quality staging data are cancer registrars, who are personnel with specialized training to abstract pertinent information with regard to the history, diagnosis, treatment, and

中文翻译：

---

提高癌症分期的质量

在这个对癌症患者进行多学科管理的时代，迫切需要与患者、肿瘤特征以及接受或计划治疗相关的准确信息，以提高所提供的护理质量。数十年来，分期一直是癌症护理的核心组成部分，肿瘤学的快速发展要求采取措施提高癌症分期的质量。医学研究所关于提高癌症护理质量的报告指出，“为了继续推进高质量的癌症护理提供系统，测量和评估改善癌症护理提供的进展，公开报告收集的信息，以及需要制定创新战略以促进绩效改进。”医学研究所的这项指控要求遵守现有的质量指标 (QI) 或措施 (QM)、实践指南，并在不存在时创建新的 QI 或 QM。美国癌症联合委员会 (AJCC) 致力于提高癌症分期的质量。QI 是定义明确、可量化的目标，可用于评估护理的结构、过程和结果。QI 必须是可衡量的、可操作的并且基于证据。此外，QI 应作为比较与许多机构的护理相关的不同指标的基准。在癌症患者护理的几个重要 QI 和 QM 中，准确和完整的癌症分期记录对患者、临床医生和公共卫生科学家具有重要意义。参与癌症患者护理的临床医生、癌症登记处和其他分期数据用户都希望 AJCC 制定和修订美国的癌症分期规则。AJCC 成立于 1959 年，自 1982 年以来一直与国际癌症控制联盟合作，为全球癌症提供统一的解剖分期系统。通过召集该领域的最佳专业知识并使用最高级别的证据，定期更新分期系统。先前版本的 AJCC 分期系统已将非解剖学预后因素纳入 TNM 框架内的某些疾病部位。目前正在考虑将分期扩大到包括广泛接受的许多其他疾病部位的相关预后因素，以开发 AJCC 分期系统的第 8 版。准确的分期使临床医生能够根据实践指南为患者提供治疗建议并讨论预后。癌症分期也是临床试验的重要纳入、排除和/或分层标准。除了其他变量之外，用于推导疾病阶段的数据元素被抽象到国家癌症数据库 (NCDB)、国家癌症研究所的监测、流行病学和最终结果 (SEER) 数据库以及疾病控制中心 (CDC) 的数据库中。 ) 国家癌症登记计划 (NPCR)。这些数据元素允许在必要时根据疾病阶段研究疾病结果和随时间的趋势，并且在制定指南、目标人群癌症控制工作和资源分配方面提供信息。重要的是，分期促进了国家和国际合作癌症研究工作，并允许来自不同文化和语言背景的临床医生交流和共享有关癌症的数据。这一点尤其重要，因为全球癌症病例负担持续上升，尤其是在低收入和中等收入国家。尽管癌症分期具有基本作用，但在实践中很难实现及时准确的分期分配和适当的记录。第一的，AJCC 分期手册部分内容的含糊不清将分期规则的解释留给了临床医生或注册员，他们中的任何一个都可能是不正确的。提高分期数据质量的关键是癌症登记员，他们是受过专门培训的人员，可以提取有关病史、诊断、治疗和治疗的相关信息。