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University of Alabama at Birmingham, Birmingham, AL 35294
WEB—This is a Web exclusive article.
Prognostic Factors in Cancer attempts to organize the available information and provide a framework for the study and use of prognostic factors. The authors argue for a need for such a framework, which is lacking even in current comprehensive textbooks on oncology. There are other books on prognostic factors for specific cancers, but this is the only book on prognostic factors for all cancer types listed in the Worldwide Library Cooperative Online Computer Library Center (Worldcat OCLC) compendium of books in print for the past 5 years [2]. It is an update of the second edition published in 2001.
The first part of the book addresses the importance of prognostic factors and discusses concepts and strategies for study and application of potential prognostic factors. Definitions, principles, and a framework are introduced, and there are chapters on design of prognostic factor studies and applications in terminal cancer and population-based cancer control. There is a chapter on incorporating molecular oncologic markers in assessing prognosis, but not one on established and emerging radiologic prognostic factors. That would be useful because techniques such as 18F-FDG PET staging and restaging after initial therapy in lymphomas and other tumors are emerging as key tools in assessing prognosis [3]. The second part of the book contains chapters on prognostic factors for specific cancers, grouped anatomically. A glossary follows with definitions of terms.
Two classification schemes for prognostic factors are applied. The first one is a formal and comprehensive division into factors that relate to the tumor, host, or environment (the latter including treatment factors). The second is a practical division into categories of relevance: essential, additional, and new and promising. With the tumor-host-environment system heading the columns of a matrix summarizing prognostic factors for each disease site, and the latter system heading the rows, this ordered approach is carried through the summaries that appear in each of the site-specific chapters of the book. Prognostic factors are discussed in the context of management scenarios throughout the chapters on each cancer type.
Prognostic Factors in Cancer meets its two major objectives of providing an organizing framework for prognostic factors and delivering a summary that spans the major tumor types. The tumor-host-environment system is comprehensive and intuitive. It is the system that many of us use in making patient treatment decisions, but we often do not apply it routinely as a framework for new prognostic factor information. The second classification system is useful in reminding us that it is the essential, validated, prognostic markers that should be used in making treatment decisions.
The rigor that this compendium strives for would be enhanced if uniform criteria were proposed that could be applied across disease types for validation of tumor prognostic factors. Most publications on particular tumor marker prognostic factors suffer from methodologic weaknesses [4]. Thus, in addition to bringing information from individual studies together, any book of this type should aim to filter the available information in a systematic way and render a distillation of the most robust factors. This book is useful toward that goal, but selection of factors was at the discretion of individual chapter authors, without prespecified criteria for inclusion of new markers.
An emerging trend is the application of tumor marker panels to parse patient groups for their likelihood of treatment benefit. A notable example is the Oncotype DX assay (Genomic Health) for breast cancer [5]. This book would be even more valuable if an attempt was made to describe in some depth the strategy and process of developing groupings of molecular factors as prognostic tools. These tools will be used to guide targeted therapies and individualize treatment. The proliferation of data on markers and marker panels will only make this type of synthesis of factors more important.
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