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Old and new markers for breast cancer prognosis: the need for integrated research on quantitative issues

2004; Elsevier BV; Volume: 40; Issue: 12 Linguagem: Inglês

10.1016/j.ejca.2004.04.026

1879-0852

Elia Biganzoli, Patrizia Boracchi,

Bioinformatics and Genomic Networks

Randomised clinical trials have shown an overall benefit for both adjuvant chemotherapy and endocrine therapy to treat breast cancer, independent of the patient's lymph node status. As adjuvant therapies have costs and side-effects associated with them, various prognostic criteria have been established to guide the indications for such treatments [ [1] Boracchi P Biganzoli E Markers of prognosis and response to treatment: ready for clinical use in oncology? A biostatistician's viewpoint. Int. J. Biol. Markers. 2003; 18: 65-69 PubMed Google Scholar ]. Particularly for patients at a low-risk of recurrence, a balance must be struck between the under-treatment of the few patients who are destined to relapse versus the unnecessary over-treatment of the majority who are already cured by loco-regional therapy. Illustrative of this problem are the disparate results of recent consensus conferences, which have attempted, using simple criteria, to define “low-risk” patients for whom adjuvant chemotherapy should not be recommended. The St. Gallen criterion [ [2] Goldhirsch A Wood W.C Gelber R.D Coates A.S Thurlimann B Senn H.J Meeting highlights: updated international expert consensus on the primary therapy of early breast cancer. J. Clin. Oncol. 2003; 21: 3357-3365 Crossref PubMed Scopus (657) Google Scholar ] indicates tumours with oesterogen receptor (ER) and/or progesterone receptor (PgR) expression, and all of the following features: pT⩽2 cm, grade I, age⩾35 years should be considered in this low-risk category, whereas the National Institutes of Health (NIH) criterion [ [3] Eifel P Axelson J.A Costa J Crowley J Curran Jr., W.J Deshler A et al. National Institutes of Health Consensus Development Conference Statement: adjuvant therapy for breast cancer, November 1-3, 2000. J. Natl. Cancer Inst. 2001; 93: 979-989 Crossref PubMed Scopus (690) Google Scholar ] proposes tumours of pT⩽1 cm should be included in this group. Obviously, the few “low-risk” patients who would have relapsed after loco-regional therapy alone stand to benefit from adjuvant therapy, atleast potentially. However, the application of these criteria would result in systemic therapy being assigned to a large number of patients who do not really need it. By the same token, within the moderate/high-risk groups, patient outcome is also highly variable and depends on biological differences among the tumours.