Prognostic and predictive factors revisited
Prognostic and predictive factors revisited
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DOI：
10.1016/j.breast.2005.08.023
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发表时间：
2005-12-01
期刊：
影响因子：
3.9
通讯作者：
Hayes, DF
中科院分区：
文献类型：
--
作者：
Hayes, DF
标准预后因素包括临床和病理分期，特别是淋巴结状态和肿瘤大小。肿瘤分级和淋巴浸润的估计似乎是中等强的预测因素，但可重复性较差，特别是对于2级肿瘤。标准的预测因素包括激素受体状态和HER-2扩增和/或过表达，分别用于内分泌治疗的选择，至少在临床试验和转移性情况下，曲妥珠单抗。三种新的标志物显得特别有希望：骨髓转移的检测，无论是在基线时还是在2-4年的随访后；UPA/PAI-1在原发癌中的表达；同时识别多个基因表达模式，或“特征”。对于每一种情况都有重要的警告。虽然新技术提供了令人兴奋和有希望的新方法来确定患者的预后，以及她是否会从特定治疗中受益，但很少有经过精心设计的证据水平I的研究得到验证。特别是，现有的数据经常被患者选择和全身治疗的效果所混淆，这些通常没有前瞻性地确定，没有包括在分析中，也没有得到充分的报道。(c) 2005 Elsevier Ltd版权所有。
Standard prognostic factors include clinical and pathological staging, especially lymph node status and tumor size. Tumor grade and estimates of lymphatic invasion appear to be moderately strong predictive factors, but reproducibility is poor, especially for grade 2 tumors. Standard predictive factors include hormone receptor status and HER-2 amplification and/or over-expression for selection of endocrine therapy and, at least for clinical trials and in the metastatic setting, of trastuzumab, respectively. Three new markers appear particularly promising: detection of bone marrow metastases, either at baseline or after 2-4 years of follow-up; expression of UPA/PAI-1 by the primary cancer; and recognition of simultaneous multiple gene expression patterns, or "signatures." Important caveats exist for each of these. Although new technologies offer exciting and promising new approaches to determining a patient's prognosis and whether she will or will not benefit from specific therapies, few have been validated in well-designed, Level of Evidence I studies. In particular, available data are often confounded by patient selection and the effects of systemic therapy, which are often not determined prospectively, not included in analyses, and not reported adequately. (c) 2005 Elsevier Ltd. All rights reserved.