A practical view of prognostic factors for staging, adjuvant treatment planning, and as baseline studies for possible...

At this time the initial prognostic assessment of breast cancer patients is still most powerfully driven by basic histopathologic information, axillary nodal involvement, and tumor size. Estrogen and progesterone receptor status are important initial pieces of information for many patients, but this information is more important in deciding the most appropriate type of treatment, rather than the prognosis of the patient. Histologic and nuclear grading can provide important prognostic information, but broader application of this information awaits better methods to ensure accuracy and decrease intraobserver variability. Whether flow cytometry-derived information can be used to select patient subsets at very low risk of relapse awaits prospective validation in cooperative group trials. A number of new prognostic tests such as cathepsin D that have shown promise in some studies await definitive prospective validation. Further development of techniques to integrate prognostic factor information and the use of this information in individualized prognostic factor decisions is needed.