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The existing TNM system was based on factors chosen, in part, because they could be obtained through a clinical examination by a physician trained to observe them. Also, the factors were chosen because they were considered to be important by the experts in the field. Yet, the sense of the comments from many cancer experts is that prognosis is not related to TNM values. If the fundamental biology of laryngeal cancer is not determined by the factors that can be observed clinically, then additional refinements cannot, theoretically, ever be made that would allow the TNM system to guide therapeutic decisions or to predict the prognosis for an individual patient.
Another sense from the comments by other observers is that "technology-based" information (eg, magnetic resonance imaging, biologic markers, and molecular genetics) should be incorporated into the process of assessing prognosis. Some real problems exist here, very analogous to what has happened