ABSTRACT

Introduction

The anatomic-based TNM classification is considered the benchmark in cancer staging and has been regularly updated since its inception. In the current era of precision medicine, the added intention for future TNM modifications is to heighten its impact in the more ‘personalized’ level of cancer care. In urologic cancers, this goal may be achieved by incorporating ‘non-anatomic’ factors into TNM, such as biomarkers (e.g. gene alterations, molecular subtypes, genomic classifiers) and risk assessment models (e.g. nomogram, look-up table), while maintaining the anatomic extent as the foundation of staging. These different prognosticators can be combined and integrated, may serve as substratifiers for T, N, or M categories, and perhaps, incorporated as elements in TNM stage groupings to enhance their prognostic capability in urologic cancers.

Areas covered

This review highlights candidate biomarkers and risk assessment models that can be explored to potentially improve TNM prognostication of bladder, prostate, kidney, and testicular cancers.

Expert opinion

Recent advances in molecular analysis have increased the understanding of the genomic, transcriptomic, and epigenetic features for biomarker use in prognostication of urologic cancers, which together with the available risk assessment models, may complement and overcome the limitations of the traditional TNM staging.

中文翻译：

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潜在的生物标志物和风险评估模型，以增强泌尿系统癌症的肿瘤-淋巴结-转移 (TNM) 分期分类。

摘要

介绍

基于解剖学的 TNM 分类被认为是癌症分期的基准，自成立以来一直定期更新。在当前精准医学时代，未来 TNM 修改的附加意图是提高其在更“个性化”的癌症护理水平中的影响。在泌尿系统癌症中，这一目标可以通过将“非解剖”因素纳入 TNM 来实现，例如生物标志物（例如基因改变、分子亚型、基因组分类器）和风险评估模型（例如列线图、查找表），同时保持解剖范围作为分期的基础。这些不同的预后因素可以组合和整合，可以作为 T、N 或 M 类别的基础，也可能作为 TNM 分期分组中的元素合并，以提高其在泌尿系统癌症中的预后能力。

覆盖区域

本综述重点介绍了候选生物标志物和风险评估模型，这些模型可用于潜在改善膀胱癌、前列腺癌、肾癌和睾丸癌的 TNM 预后。

专家意见

分子分析的最新进展增加了对用于预测泌尿系统癌症的生物标志物的基因组、转录组和表观遗传特征的理解，与可用的风险评估模型一起，可以补充和克服传统 TNM 分期的局限性。