Potential biomarkers and risk assessment models to enhance the tumor-node-metastasis (TNM) staging classification of urologic cancers

Expert Rev Mol Diagn. 2020 Sep;20(9):921-932. doi: 10.1080/14737159.2020.1816827. Epub 2020 Sep 20.


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.

Keywords: TNM; Urologic; biomarker; bladder; prognostic.

MeSH terms

  • Biomarkers, Tumor*
  • Disease Management
  • Disease Susceptibility
  • Humans
  • Lymphatic Metastasis
  • Neoplasm Staging* / methods
  • Precision Medicine / methods
  • Prognosis
  • Urologic Neoplasms / diagnosis*
  • Urologic Neoplasms / etiology*


  • Biomarkers, Tumor