[New prognostic markers in colorectal cancer]

The majority of patients diagnosed as having colorectal cancer do not survive five years, although 70%-80% undergo curative surgery. Only a minority of the patients receive additional adjuvant chemo-, radio- and/or immunotherapy, which has proven its efficiency in a minor part of patients with Dukes C disease. Therefore, adjuvant therapy has only an insignificant impact on overall survival improvement. The present treatment of patients with colorectal cancer is far from sufficient, and this has led to considerations of how to optimize both surgical and adjuvant medical treatment strategy. Current biotechnological research in tumour biology has led to the development of several new treatment modalities, and within few years some of these will be tested clinically. It cannot be expected that all modalities may prove equally efficient in all patients. Furthermore, half the operated patients are cured by surgery alone, and these should not receive additional adjuvant treatment. Therefore, considerations are required of how to implement new modalities, and of selection of patients who are expected to benefit from a specific modality or a combination of modalities. It is suggested, that new biological markers of development, growth and dissemination of colorectal cancer can be used to predict prognosis either alone or in various combinations, and as selection markers to discriminate between patients who only need surgery and patients who may need adjuvant treatment.