Prognostic and predictive factors in early-stage breast cancer
Prognostic and predictive factors in early-stage breast cancer
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DOI：
10.1634/theoncologist.9-6-606
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发表时间：
2004-01-01
期刊：
影响因子：
5.8
通讯作者：
Goldstein, LJ
中科院分区：
文献类型：
--
作者：
Cianfrocca, M;Goldstein, LJ
乳腺癌是美国妇女中最常见的恶性肿瘤。由于筛查的增加，大多数患者都患有早期乳腺癌。牛津综述分析表明，辅助激素治疗和综合化疗降低了乳腺癌复发和死亡的风险。然而，辅助全身治疗具有相关的风险，并且能够最佳地选择最有可能受益的患者将是有用的。辅助全身治疗的目的是根除远处微转移沉积物。因此，必须能够估计一个单独的病人的风险窝藏临床沉默微转移性疾病使用既定的预后因素。能够基于已建立的预测因素为个体患者选择最佳辅助治疗也是有益的。标准做法是对所有淋巴结阳性疾病患者进行全身治疗。然而，淋巴结阳性妇女之间存在明显差异，可能需要更积极的治疗方法。此外，有许多淋巴结阴性的妇女也将受益于辅助全身治疗。因此，预后因素必须与预测因素区分开来。预后因素是在手术时可用的任何测量，其与在没有全身辅助治疗的情况下的无病生存或总生存相关，并且因此能够与疾病的自然史相关。相反，预测因子是与对给定疗法的响应相关的任何测量。一些因素，如激素受体和HER 2/neu过表达，是预后和预测。
Breast cancer is the most common malignancy among American women. Due to increased screening, the majority of patients present with early-stage breast cancer. The Oxford Overview Analysis demonstrates that adjuvant hormonal therapy and polychemotherapy reduce the risk of recurrence and death from breast cancer. Adjuvant systemic therapy, however, has associated risks and it would be useful to be able to optimally select patients most likely to benefit. The purpose of adjuvant systemic therapy is to eradicate distant micrometastatic deposits. It is essential therefore to be able to estimate an individual patient's risk of harboring clinically silent micrometastatic disease using established prognostic factors. It is also beneficial to be able to select the optimal adjuvant therapy for an individual patient based on established predictive factors. It is standard practice to administer systemic therapy to all patients with lymph node-positive disease. However, there are clearly differences among node-positive women that may warrant a more aggressive therapeutic approach. Furthermore, there are many node-negative women who would also benefit from adjuvant systemic therapy. Prognostic factors therefore must be differentiated from predictive factors. A prognostic factor is any measurement available at the time of surgery that correlates with disease-free or overall survival in the absence of systemic adjuvant therapy and, as a result, is able to correlate with the natural history of the disease. In contrast, a predictive factor is any measurement associated with response to a given therapy. Some factors, such as hormone receptors and HER2/neu overexpression, are both prognostic and predictive.