Path Toward Prognostication and Prediction: An Evolving Matrix

摘要: The popular buzz phrase “personalized medicine” represents an attractive concept to patients and clinicians alike with its promise of optimizing therapeutic results minimizing toxicities that can be linked biologic characteristics each individual. Certainly it is true, or at least should routinely attempt harmonize individual patient circumstances when formulating recommendations selecting oncology care plan. Factors are usually considered include disease stage other pathologic findings, selected molecular factors, psychosocial issues, expectations perceptions the family members, performance status, comorbidities, symptoms. quest apply highly specific host and/or tumor profiles as prognostic predictive markers, however, has been elusive cast personalized medicine more a work in progress future goal rather than current reality. ability prognosticate based on data from population observations over time, which segregate by provide survival statistics for given subset patients, regardless treatment intervention. introduction factors into discussions between clinician potential inform decisions risk recurrence. Once estimated recurrence determined available data, focus discussion centers options intervention monitoring approaches, particularly who have cure their major goal. Although considering recurrence, well benefits harms intervention, critical decision making, too often oncologist limited estimating benefit because lack strong clinically validated factors. Indeed, one greatest challenges cancer need fuse markers derived studies groups cohesive assessment relevance patient, including risks both interventions. Prognostic determination colorectal carcinoma long centered most powerful predictor outcome. Colorectal staging further refined seventh edition American Joint Committee Cancer manual (AJCC-7) published 2010, stages II III disease. New subsets now listed new lymph node subsets, information generated National Data Base Surveillance, Epidemiology End Results database. latest AJCC exemplifies offered well-constructed databases generate integrated tool. Furthermore, development robustly annotated clinical cancer, those international trials, collection specimens these databases, opportunities identify additional biomarkers become feasible. widely used T (depth invasion) N (lymph metastasis) categories define without distant metastasis. On basis well-established prognosis improvement after adjuvant chemotherapy, colon treated postoperative chemotherapy surgery alone, despite wide variability among disease, especially AJCC-7. In contrast guidelines, findings taken consideration decisions, histologic grade, perineural invasion, lymphovascular inadequate number nodes sampled, length negative margins, perforation, along obstruction. Preand carcinoembryonic antigen marker also used, not only predict but tool During last few years, (ie, microsatellite instability [MSI] status) emerged relevant select cancer. High levels MSI (MSI-H) characteristic Lynch syndrome (hereditary nonpolyposis syndrome). addition, Sargent et al reported pooled analysis enrolled onto five completed randomized trials fluorouracil levamisole leucovorin versus alone evaluate outcome deficient mismatch repair (dMMR) defined presence either JOURNAL OF CLINICAL ONCOLOGY E D I O R A L S VOLUME 29 NUMBER 35 DECEMBER 1