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My impression is that there have not been any major new developments
that override the overall consensus reached at Prout's Neck. I would
have liked to have seen more papers examining the prognostic
significance of S-phase following cytokeratin gating, since this is likely to
be more informative. I have not seen much published addressing the
prognostic significance of hypodiploid or hypertetraploid tumours; our
impression was that these may represent poor prognosis subsets, but at
the time of the meeting we felt the data were insufficient to reach a firm
consensus.
I contnue to be impressed that despite major progress understanding the
molecular basis of aberrant growth regulation in cancer, S-phase still
hangs in as a useful prognostic marker in breast cancer. I stopped doing
the test myself as soon as I had completed my large study that was
published in Cancer Res in 1987, on the assumption that within a couple
of years the molecular pathologists would have blown us out of the water
with some cheap oncogene tests. I still think this will happen, but it seems
likely that aberrant growth regulation in breast cancer is sufficiently
complex that a crude readout such as S-phase is more useful than
measuring individual oncogene products.
So far as what types of breast cancer should be examined by DNA flow
cytometry is concerned, my feeling is that this is intimately tied in with what
the oncologist plans to do with any additional prognostic information. High
S-phase is probably of prognostic utility in all disease stages, although I
personally would not make a major therapeutic decision on the basis of
S-phase alone. Probably the most useful clinical situation would be in T1
N0 premenopausal patients. More advanced stages tend to get adjuvant
chemotherapy regardless of other prognostic factors. Super aggressive
treatments involving autologous bone marrow transplantation are still in an
experimental phase, and are used when the prognosis is so bad that it's
unlikely a low S-phase would be considered a contra-indication.
David Hedley
Princess Margaret Hospital/Ontario Cancer Institute
Toronto
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