Small Stress Proteins pp 205-218
Hsp27 as a Prognostic and Predictive Factor in Cancer
Once the diagnosis of a particular type of cancer has been established, the physicians need to know the aggressiveness of the tumor in order to decide which treatments should be applied. The aggressiveness of the malignant tumor is evaluated by the clinic (e.g., growth rate or given symptoms), by laboratory/image data (e.g., presence of tumor markers in serum, local/distant extension evaluated by CAT scan), and by histopathology (e.g., tumor size, tumor subtype, nuclear grade, lymph node invasion). In the last few years, molecular markers are progressively being incorporated in order to better define the tumor aggressiveness and the treatment options for a particular cancer, and more importantly, for a particular patient. Prognostic factors are those measurements available at the time of diagnosis or surgery that are associated with disease-free survival (DFS) or overall survival (OS) (Clark 1999). In a strict sense, these factors should be evaluated in the absence of systemic adjuvant therapy which is often difficult to achieve. On the other hand, predictive factors are those measurements indicating the response to a particular treatment. Predictive factors may also be useful in the prognosis, e.g., the presence of estrogen receptor (ER) a and progesterone receptor (PR) predicts the responsiveness to tamoxifen in breast cancer patients and these receptors are also associated with a better prognosis. However, sometimes prognostic and predictive factors are not associated, for example, lymph node invasion is useful for disease prognosis but is not associated with the response to a particular therapy.
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