title: The clinical implications of integrating additional prognostic factors into the TNM.
abstract: OBJECTIVE
  The management of solid tumors is governed by host and tumor factors that traditionally have incorporated TNM staging with additional pathologic, biologic, and clinical host factors. Beyond the anatomic-based TNM, increasingly new prognostic and predictive factors are being discovered that have important survival and treatment implications. However, because the TNM is based on a "bin" model, additional prognostic factors would rapidly overwhelm the current system. This communication demonstrates the clinical implications and improved patient prognosis derived from a new algorithmic model based on clustering analysis.
  
  
  METHODS
  A new algorithm is described that integrates additional factors into the TNM and calculates survival.
  
  
  RESULTS
  The results indicate that additional factors can be integrated into the TNM staging system providing additional patient stratification without changing the TNM definitions. Adding prognostic factors to traditional TNM staging increases substratification of given stages and identifies and separates favorable and unfavorable clinical outcomes for specific TNM stages.
  
  
  CONCLUSIONS
  Integration of additional prognostic factors into the TNM by a clustering algorithm can change the stratification of patient outcome. This may guide the clinician to select a more rational management program based on the additional factors and improve cohort selection for clinical trials.
authors: Division of Cancer Control and Epidemiology, The George Washington University Cancer Institute, Washington, District of Columbia.
authors: Donald Earl
authors: DE
authors: Henson
authors: Arnold M
authors: AM
authors: Schwartz
authors: Dechang
authors: D
authors: Chen
authors: Dengyuan
authors: D
authors: Wu
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000401:mortality; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate
keywords: TNM; combinations; prognostic factors; staging; survival rates