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Prognosis and Prediction

Prognosis and Prediction

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Published by Rudi Anz Ansyah
prognosis dan prediksi kanker
prognosis dan prediksi kanker

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Published by: Rudi Anz Ansyah on Aug 28, 2013
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Prognosis and prediction
Prognostic and predictive markers are both of high relevance in therapeutic decision procedures in order toindividualize treatment, but they have distinct roles. Prognostic and predictive factors may be derived fromeither the characteristics of the patient or the tumor type. Prognostic factors intend to predict objectively andindependently patient clinical outcome independent of treatment, while predictive factors aim to foretell theresponse of a patient to a specific therapeutic intervention and are associated with tumor sensitivity or resistance to that therapy. Prognostic factors necessarily require definition in patient cohorts that did notundergo systemic adjuvant treatment.Predictive markers may be the target of a specific therapy itself. For example, the oncogene
 HER2
is the targetof the monoclonal antibody trastuzumab, and
 HER2
amplification predicts for a good response to anti-HER2therapy. It is important to note that HER2 status is also prognostic, and like many factors, it has mixed prognostic/predictive significance. Similarly Ki67, which will be discussed in more detail below, as a marker of proliferation displays a strong prognostic effect, but it also appears to predict for a good response tosystemic chemotherapy. In general, prognostic markers help to determine whether a patient requires treatment,and a predictive factor is useful in deciding which treatment will be the best.Lately, there has been an increase in implementation of marker combinations to define treatment-specific prognoses. This is of special interest to define the residual risk of recurrence when a patient is treated in aspecific manner and to evaluate the potential importance of further treatment options. Great efforts, especiallyon the transcriptome level, have been made to discriminate which ER-positive early breast cancer patientswould really benefit from additional chemotherapy and who could be spared of it and the side effects. Theability to do this was highlighted as the top priority question in breast cancer translational research in aninternational survey of breast cancer specialists(Dowsett
a
).
Understanding Cancer Prognosis
 
Key Points 
 
 A prognosis is an estimate of the likely course and outcome of a disease.
 
Many factors affect the prognosis of a person with cancer, including the type, location, and stage of the cancer.
 
When estimating a patient’s prognosis, doctors usually use statistics based on data from groups of 
people whose situations are most similar to that of the patient.
 
Doctors cannot estimate with certainty what the outcome will be for an individual cancer patient.
1. What is a prognosis?
 A prognosis is an estimate of the likely course and outcome of a disease. The prognosis of a patientdiagnosed with cancer is often viewed as the chance that the disease will be treated successfullyand that the patient will recover.
2.
What factors affect a patient’s prognosis?
 
Many factors can influence the prognosis of a person with cancer. Among the most important are thetype and location of the cancer, the stage of the disease (the extent to which the cancer has spread
in the body), and the cancer’s grade (how abnormal the cancer cells look under a microscope—
anindicator of how quickly the cancer is likely to grow and spread).
 
Other factors that affect prognosis include the biological and genetic properties of the cancer cells(these properties, which are sometimes calledbiomarkers,can be determined by specific labandimaging tests
), the patient’s age and overall general health,
 
and the extent to which the patient’s
cancer responds to treatment.
3.
How do statistics contribute to predicting a patient’s prognosis?
 
In estimating a cancer patient’s prognosis, doctors consider the characteristics of the patient’s
disease, the available treatment options, and any health problems the patient may have that couldaffect the course of the disease or its ability to be treated successfully.The doctor bases the prognosis, in large part, on information researchers have collected over manyyears about hundreds or even thousands of people with the same type of cancer. When possible,doctors use statistics based on groups of people whose situations are most similar to that of thepatient.Several types of statistics may be used to estimate a cancer 
patient’s prognosis. The most
commonly used statistics are listed below.
o
 
Cancer-specific survival: This statistic calculates the percentage of patients with a specific typeandstageof cancer who have survived
that is, not died from
their cancer during a certain periodof time (1 year, 2 years, 5 years, etc.) after diagnosis. Cancer-specific survival is alsocalled
disease-specific 
 
survival 
. In most cases, cancer-specific survival is based on causes of deathin medical records, which may not be accurate. To avoid this inaccuracy, another method used toestimate cancer-specific survival that does not rely on information about the cause of deathis
relative survival 
.
o
 
Relative survival: This statistic compares the survival of patients diagnosed with cancer (for example, breast cancer) with the survival of people in the general population who are the same age,race, and sex and who have not been diagnosed with that cancer. It is the percentage of cancer patients who have survived for a certain period of time after diagnosis
relative
to people withoutcancer.
o
 
Overall survival: This statistic is the percentage of patients with a specific type and stage of cancer who are still alive
that is, have not died from any cause
during a certain period of time after diagnosis.
o
 
Disease-free survival: This statistic is the percentage of patients who have no evidence of cancer during a certain period of time after treatment. Other similar terms arerecurrence-freeor progression-free survival. Cancer survival statistics are frequently given in terms of 5-year survival relative to the generalpopulation (that is, as 5-
year relative survival percentages or ―rates‖). For exampl
e, according to
NCI’s Surveillance, Epidemiology, and End Results program, the 5
-year relative survival ratefor allwomen diagnosed with breast cancer during the period from 2001 through 2007 was 89 percent andthe 5-year relative survival rate for all patients diagnosed with lung cancer during the same periodwas 16 percent.
 
Because survival statistics are based on large groups of people, they cannot be used to predictexactly what will happen to an individual patient. No two patients are entirely alike, and their treatment and responses to treatment can vary greatly. Also, because it takes years to see theimpact of new treatments anddiagnostic tests,the statistics a doctor uses to make a prognosis maynot reflect the effectiveness of current treatments.Nevertheless, the doctor may speak of a favorable prognosis if the information from large groups of people suggests that the cancer is likely to respond well to treatment. A prognosis may beunfavorable if the cancer is likely to be difficult to control. It is important to keep in mind, however,that a prognosis is only an estimate. Again, doctors cannot be absolutely certain about the outcomefor an individual patient.
4. Is it helpful to know the prognosis?
Cancer patients and their loved ones face many unknowns. Understanding their disease and what toexpect can help patients and their loved ones make decisions about treatment, supportiveandpalliative care,rehabilitation,and personal matters, such as financial matters. Seeking information about prognosis is a personal decision.Many people with cancer want to know their prognosis. They find it easier to cope when they knowthe likely course of their disease. Some patients may ask their doctor about survival statistics or search for this information on their own. Other people find statistical information confusing andfrightening, and they think it is too impersonal to be of value to them. It is up to each patient todecide how much information he or she wants.
 A doctor who is most familiar with a patient’s situation is in the bes
t position to discuss his or her prognosis and explain what the statistics may mean.
5. What is the prognosis if a patient decides not to have treatment?
Because everyone’s situation is different (see Question 2), this question can be difficult to answer.
 Also, information used in making a prognosis often comes from studies that have compared new
treatments with existing treatments rather than with ―no treatment.‖ Therefore, it is not always easy
for doctors to accurately estimate the prognosis of a patient who decides not to have treatment.
However, as mentioned above (see Question 4), a doctor who is most familiar with a patient’s
situation is in the best position to discuss his or her prognosis.There are many reasons why patients may decide not to have treatment. Some patients may beconcerned that the benefits of cancer treatments will be outweighed by the side effects. Patientsshould discuss this concern with their doctor or other health care provider. Many medications areavailable to prevent or control the side effects caused by cancer treatments.Some patients may decide at some point not to have treatment if they know that their typeandstageof cancer has a poor prognosis, despite treatment. Patients who choose not to have activecancer treatment should talk with their doctor to ensure that they getpalliative treatmentto help withthe symptoms caused by their disease.

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