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Prognostische und prädiktive Faktoren invasiver Mammakarzinome

Update 2009

Prognostic and predictive factors of invasive breast cancer

Update 2009

  • Schwerpunkt: Mammapathologie
  • Published:
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Zusammenfassung

Prognosefaktoren geben Informationen über den Krankheitsverlauf (Rezidivfreiheit und Gesamtüberleben), die unabhängig von der Therapie sind. Zu ihnen gehören der axilläre Lymphknotenstatus, Tumordurchmesser und histologischer Differenzierungsgrad, Lymph- und Blutgefäßinvasion sowie das Staging – Faktoren, die alle durch den Pathologen bestimmt werden. Der „Nottingham Prognostic Index“ (NPI) vereint die stärksten Prognosefaktoren und ist nach Studienergebnissen als Modell für die Brustkrebsprognose geeignet.

Prädiktive Faktoren sagen die Wahrscheinlichkeit des Ansprechens eines Tumors auf eine bestimmte Therapie voraus. Hierzu gehören der Hormonrezeptorstatus, die Invasionsmarker uPA/PAI-1, der Nachweis von isolierten Tumorzellen, ein Residualtumor und der histologische Resektionsrand.

Prognostische oder prädiktive Faktoren sind klinisch relevant, wenn durch ihre Kenntnis Therapieentscheidungen ermöglicht werden, die zu einer Verbesserung des Gesamtüberlebens, des rezidivfreien Überlebens oder der Lebensqualität führen. Die internationale Konsensempfehlung von St. Gallen 2007 fordert als Grundlage für risikoadaptierte Therapieentscheidungen: Tumorgröße, Grad, Alter, Nodalstatus, Hormonrezeptorstatus sowie Her2-Überexpressions- oder -Amplifikationsstatus.

Abstract

Prognostic factors supply information on the course of a disease (recurrence-free and total survival) and are independent of the therapy. The most important prognostic factors are lymph node status, tumor diameter and histological differentiation stage, lymph and blood vessel invasion as well as staging, factors which can all be determined by pathologists. The Nottingham prognostic index (NPI) combines the strongest prognostic factors and according to study results is a suitable model for prognosis of breast cancer.

Predictive factors give prior information on the probability of the response of a tumor to a defined therapy and include hormone receptor status, the invasion marker uPA/PAI-1, detection of isolated tumor cells, a residual tumor and the histological resection border.

Prognostic or predictive factors are clinically relevant when therapy decisions are made possible by their recognition, which lead to an improvement in the total survival, recurrence-free survival or quality of life. The international consensus recommendation of St. Gallen 2007 requires the following as a basis for risk-adapted therapy decisions: tumor size, stage, age, nodal status, hormone receptor status and Her2 overexpression or amplification status.

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  1. Brust-Screening-Pathologie, Gerhard-Domagk-Institut für Pathologie, Universitätsklinikum Münster, Domagkstr. 17 , 48149, Münster, Deutschland

    T. Decker, D. Hungermann & W. Böcker

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Decker, T., Hungermann, D. & Böcker, W. Prognostische und prädiktive Faktoren invasiver Mammakarzinome. Pathologe 30, 49–55 (2009). https://doi.org/10.1007/s00292-008-1105-0

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