Tumor prognosis

Metastatic renal cell carcinoma has a poor prognosis and resists conventional chemotherapy. Immunotherapy with IL-2 and/or IFN-a is currently regarded as the most effective therapy with, however, modest response rates of 15-20%. Similar results are also observed in patients with metastatic melanoma and the response to IFN-a and IL-2 correlates with the occurrence of tumor-infiltrating CD4+ T-lymphocytes identified in aspirates from melanoma metastases. Determination of these cells therefore seems to be a method to predict responders prior to the initiation of cytokine therapy. 

Cornetta K, Croop J, Dropcho E, Abonour R, Kieran MW, Kreissman S, Reeves L, Erickson LC, Williams DA (2006) A pilot study of dose-intensified procarbazine, CCNU, vincristine for poor prognosis brain tumors utilizing fibronectin-assisted, retroviral-mediated modification of CD34-I- peripheral blood cells with 06-methylguanine DNA methyltransferase. Cancer Gene Ther 13 886-895... 

Tumor size. In general, patients with a larger tumor have a worse prognosis. 

Hormone-receptor status. Patients with negative-estrogen-receptor (ER) and negative-progesterone-receptor (PR) tumors have a worse prognosis. 

Over 90% of colon cancers are adenocarcinomas and are assigned a grade of I to III based on how similar they are to normal colon cells. Grade I tumors most closely resemble normal cellular structure, whereas, grade III tumors frequently have lost the characteristics of mature normal cells. Grade III tumors are associated with a worse prognosis than grade I tumors.8... 

The prognosis for prostate cancer patients depends on the histologic grade, the tumor size, and the disease stage. More than 85% of patients with stage Aj disease but less than 1% of those with stage D2 can be cured. 

Undifferentiated tumors are associated with a poorer prognosis than lesions that are considered to be well or moderately differentiated. 

Overall survival is affected by the success of the initial surgery to debulk the tumor to less than 1 cm of disease and response to first-line chemotherapy. The CA-125 level should be monitored with each cycle, and at least a 50% reduction in CA-125 after four cycles of taxane/platinum chemotherapy is related to an improved prognosis. Patients who achieve a complete response should have follow-up examinations every 3 months, including CA-125 determination, physical examination, pelvic examination, and appropriate diagnostic scans (e.g., CT scan, MRI, or PET scan) and should be evaluated for the detection of disease. Evaluate patients for resolution of any residual chemotherapy-related side effects, including neuropathies, nephrotoxicity, ototoxicity, myelosuppression, and nausea/vomiting. 

Stage of colorectal cancer should be determined at diagnosis to predict prognosis and to develop treatment options. Stage is based on the size of the primary tumor (T ), presence and extent of lymph node involvement (N0-2) and presence or absence of distant metastases (M). 

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