Biomolecular prognostic factors in breast cancer
Biomolecular prognostic factors in breast cancer
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DOI：
10.1097/00001703-200402000-00010
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发表时间：
2004-02-01
影响因子：
2.1
通讯作者：
Daidone, MG
中科院分区：
文献类型：
--
作者：
Coradini, D;Daidone, MG
综述目的为了更新临床医生对乳腺癌生物标志物临床实用性的最新发现，本综述检查了最近发表的关于有希望的预后/预测生物学因素的论文。这些因子可以根据它们参与肿瘤细胞特征性的主要改变来分类：生长信号自给自足、对抗生长信号不敏感、逃避细胞凋亡、无限的复制潜能、持续的血管生成、以及组织侵袭和转移。最近的发现尽管进行了相关的研究努力并鉴定了许多假定的良好的促增殖剂，这些因素中很少有被证明在临床上可用于识别复发风险最小的患者、预后较差的患者或可能从特定治疗中获益的患者。其中大多数，如HER-2/neu，表皮生长因子受体，细胞周期蛋白E，p53，bcl-2，血管内皮生长因子，尿激酶型纤溶酶原激活剂-1和最近发现的抗凋亡蛋白生存素，建议可能列入具有高水平的临床实验室有效性的生物标志物的类别。然而，没有单一的生物标志物能够识别具有最佳（或最差）预后的患者或对给定治疗有反应的患者。来自基因表达分析的新发现表明，同时考虑有助于癌症标志的分子改变可能提供临床上有用的预后，也许治疗，信息。总结实验室发现到临床实践的快速转化受到许多困难的阻碍，包括技术和统计问题，缺乏测定标准化和可比性，以及转化研究的适度设计。许多研究在太小的患者系列中进行，无法提供可靠的结果;这些研究在治疗，患者和肿瘤特征方面通常是异质性的，并且数据可能使用不同的分析方法进行评估，因此不容易比较。为了评估生物标志物测定的临床效用，需要进行详细计划的前瞻性研究。
Purpose of review To update clinicians on recent findings concerning the clinical usefulness of biomarkers in breast cancer, this review examines recently published papers dealing with promising prognostic/ predictive biological factors. These factors can be classified according to their involvement in the main alterations characterizing tumor cells: self-sufficiency in growth signals, insensitivity to anti-growth signals, evasion of apoptosis, limitless replicative potential, sustained angiogenesis, and tissue invasion and metastasis.Recent findings Despite relevant research efforts and the identification of many putative good prognosticators, few of these factors are proving clinically useful for identifying patients at minimal risk of relapse, patients with a worse prognosis, or patients likely to benefit from specific treatments. Most of them, such as HER-2/neu, epidermal growth factor receptor, cyclin E, p53, bcl-2, vascular endothelial growth factor, urokinase-type plasminogen activator-1 and the recently discovered anti-apoptosis protein survivin, are suggested for possible inclusion in the category of biomarkers with a high level of clinico-laboratory effectiveness. However, no single biomarker was able to identify those patients with the best (or worst) prognosis or those which would be responsive to a given therapy. Novel findings derived from gene-expression analysis indicate that the simultaneous consideration of molecular alterations contributing to the hallmarks of cancer might provide clinically useful prognostic, and perhaps therapeutic, information.Summary Rapid translation of laboratory findings to clinical practice was hampered by many difficulties, including technical and statistical concerns, a lack of assay standardization and comparability, and the modest design of translational studies. Many studies are performed on too small series of patients to provide reliable results; the studies are often heterogeneous in terms of treatment, patients and tumor characteristics, and data may be evaluated using different analytical approaches and are thus not easily comparable. Adequately planned prospective studies are required to assess the clinical utility of biomarker determinations.