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History
The TNM classification of cancer was developed between 1943 and 1952 by Prof. Pierre Denoix at the Institute Gustave-Roussy. The UICC subsequently established a Special Committee on Clinical Stage Classification under the Chairmanship of Dr Denoix. The Committee and its direct descendant, the UICC TNM Prognostic Factors Project, continued to develop the TNM Classification. The pocket book, Livre de Poche, first published in 1968, is now in its 7th edition.
At the same time as the UICC was developing the TNM Classification, the International Federation of Gynecology and Obstetrics (FIGO) developed the FIGO Classification for Gyneacological malignancies. A little later, the American Joint Committee for Cancer (AJCC) began publishing separate definitions of TNM categories.
In 1987 the UICC and the AJCC TNM classifications were unified.
Currently an agreement between the UICC, AJCC and FIGO ensures compatibility of staging classifications for gynaecological malignancies as well as other cancers (link to milestones).
During the last 50 years advances in diagnosis and treatment and understanding in the prognosis of cancer has resulted in changes in TNM, and prognostic factors other than those that are anatomically based have been identified for various tumor sites. Several are already incorporated into TNM:
- histologic grade is incorporated into soft tissue sarcoma, bone and prostate tumors,
- age and histology into thyroid tumors
- serum markers in testis and gestational trophoblastic tumors.
Currently an increasing number of biologic and genetic prognostic factors are being recognized for many different tumor sites, and this is a rapidly expanding and changing field. For instance, there are increasing data demonstrating that certain genetic mutations are associated with different prognoses and possibly different outcomes to therapy. However, data from early studies are often not confirmed by later studies, and some novel tests, might be difficult to implement in all healthcare systems worldwide. The main method to decide when and what changes should be introduced to the TNM classification is consensus of experts. To bring more evidence to this process, the UICC has developed a mechanism to enhance the procedure for continuous improvement of the TNM classification. This process includes the standardized review of any proposals for changes and the literature watch to identify new knowledge suggesting the need for changes to the TNM system. The site specific panels of internationally recognized experts have been formed to help with the process. Read related article ‘The process for continuous improvement of the TNM classification’.
| 1940s | Dr Pierre Denoix developed the TNM Classification of Cancer Stage at the Institut Gustave-Roussy, France. Subsequently, UICC established a Committee on Clinical Stage Classification under his leadership and continued to develop the TNM Classification. |
| 1953 | Publication of the “Uniform Technique for a Clinical Classification by the TNM System” (1). |
| 1968 | UICC TNM pocket book, “the Livre de Poche”, 1st edition |
| 1974 | UICC Livre de Poche, 2nd edition |
| 1982 | UICC TNM Classification, 3rd edition
In subsequent years |
| 1982 | UICC TNM Atlas, 1st edition, a graphic guide to the TNM Classification |
| 1985 | UICC TNM Atlas, 2nd edition |
| 1987 | Unification of the UICC and AJCC TNM classifications
UICC TNM Classification of Malignant Tumours, 4th edition |
| 1989 | UICC TNM Atlas, 3rd edition |
| 1993 | UICC TNM Supplement, 1st edition, a commentary on uniform use |
| 1995 | UICC Prognostic Factors, 1st edition |
| 1997 | UICC TNM Classification of Malignant Tumours, 5th edition UICC TNM Atlas, 4rd edition |
| 1998 | UICC TNM Interactive CD Rom |
| 2001 | UICC TNM Supplement, 2nd edition UICC Prognostic Factors, 2nd edition |
| 2002 | UICC TNM Mobile Edition 2.0 UICC TNM Classification of Malignant Tumours, 6th edition |
| 2003 | UICC TNM Online / Wiley UICC TNM Supplement, 3rd edition |
| 2004 /2005 | UICC TNM Atlas, 5th edition |
| 2006 | Prognostic Factors in Cancer, 3rd edition |
Note
1. It was accepted as the basis for the classification proposals for breast and laryngeal cancer by the International Commission on Stage Grouping of Cancer and the Presentation of Results (ICPR).
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