Prognostic markers

Miller K, Ibrahim M, Barnett S, et al. Technical aspects of predictive and prognostic markers in breast cancer what UK NEQAS data shows. Curr. Diagn. Pathol. 2007 13,135-149. 

By best research evidence Sackett means clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic,... 

The presence or absence of metastases in local lymph nodes is widely used as a prognostic marker. Generally, patients with metastasis in these lymph nodes have a significantly poorer outcome than those patients without metastases. However, at least in the case of breast cancer, about 25-30% of node-negative patients die from their disease within 10 years. As mentioned earlier, there is a particular urgent need for new markers to identify those high-risk, axillary node-negative breast cancer patients. 

In recent years, a large number of new biochemical prognostic markers have been described for cancer. These include steroid receptors, cellular or c-onco-genes, suppressor genes, and molecules directly involved in metastasis, such as proteases and adhesion proteins. 

Preliminary evidence suggest that c-erbB-2 may also be a prognostic marker for other cancers such as gastric (Y2), ovarian (S7), cervical (K5), and nonsmall cell carcinoma of the lung (K3). Thus, c-erbB-2 has the potential to be a prognostic marker for many different types of adenocarcinomas. 

As with c-erbB, overexpression of the suppressor p53 gene product has been found in different cancers (H3). Initially, it was believed that the detection of p53 protein in tumors meant the presence of a mutant gene product. However, we now know that normal p53 protein can be overexpressed in response to certain stimuli and stabilized by interaction with both cellular and viral proteins (H3). Irrespective of the mechanism giving rise to elevated protein levels, overexpression of p53 has been shown to be a prognostic marker in both breast and colorectal cancers (D8). In some studies, the presence of high levels of p53 has been shown to be a prognostic marker in axillary node-negative breast cancer patients (H3). 

Biochemical Prognostic Markers or Potential Prognostic Markers for Different Human Cancers... 

A summary of the different prognostic markers for human cancers mentioned earlier is given in Table 4. It should be remembered that for many of these markers, results are still preliminary. Apart from ER and PR for breast cancer, none are in routine use. However, uPA is a potential prognostic marker for axillary node-negative breast cancer. 

D8. Duffy, M. J., Cellular oncogenes and suppressor genes as prognostic markers in cancer. Clin. Biochem. 26, 439-447 (1993). 

D9. Duffy, M. 1., Reilly, D., McDermott, E., O Higgins, N., Fennelly, J. J., and Andreasen, P. A., Urokinase plasminogen activator as a prognostic marker in different subgroups of patients with breast cancer. Cancer (Philadelphia) 74, 2276-2280 (1994). 

Unlike differentiation antigens, prognostic markers are usually evaluated semiquantitatively, both in terms of the proportion of tumor cells showing positivity and the strength of the reaction. 

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