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Staging in the era of international databases: documented improvements with remaining challenges.

Between 1943 and 1952, Pierre Denoix, a surgeon at the Institute Gustave Roussy in Paris, developed, proposed and published a classification system for all solid tumors based on the size and extension of the primary tumor, its lymphatic involvement, and the presence/absence of metastases, and ever since, the resulting tumor-nodemetastasis (TNM) staging system has been the international standard used by both the American Joint Commission on Cancer (AJCC) and the Union Internationale Contre le Cancer (UICC) (1).