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Related Experiment Videos

When is a prognostic factor useful? A guide for the perplexed.

M N Levine1, G P Browman, M Gent

  • 1Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology
|February 1, 1991
PubMed
Summary
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Selecting prognostic tests for early-stage breast cancer is crucial. This study guides clinicians in choosing tests that accurately predict recurrence risk, aiding treatment decisions.

Area of Science:

  • Oncology
  • Biomarkers
  • Clinical Decision Support

Background:

  • Traditional prognostic factors for early-stage breast cancer are established but may lack precision.
  • Emerging molecular markers, including tumor proliferative index and gene amplification, show promise for outcome prediction.
  • Clinical practitioners face challenges in selecting the most effective prognostic tests for routine use.

Purpose of the Study:

  • To guide clinicians in identifying prognostic tests that best predict adverse outcomes in early-stage breast cancer.
  • To evaluate the added clinical utility of new prognostic tests compared to traditional factors.
  • To provide a framework for selecting tests that discriminate between high- and low-risk patients.

Main Methods:

  • Review of methodologic guidelines for evaluating prognostic test accuracy.

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  • Emphasis on criteria such as inception cohort assembly, blinding, complete follow-up, and statistical analysis.
  • Development of an approach to aid clinicians in test selection for their practice.

    • Main Results:

    • Prognostic usefulness of a test is quantified by relative risk (RR).
    • Key methodologic criteria are essential for reliable prognostic test evaluation.
    • A systematic approach can help clinicians choose optimal tests or combinations.

    Conclusions:

    • Accurate prognostic testing is vital for tailoring adjuvant therapy in breast cancer.
    • Careful evaluation of test methodology and performance is necessary.
    • Informed patient decisions require clear presentation of risks and benefits based on prognostic data.