Muñoz Montserrat, Estévez Laura G, Alvarez Isabel, Fernández Yolanda, Margelí Mireia, Tusquets Ignasi, Seguí Miguel Angel, Lluch Ana
Hospital Clinic i Provincial, Servicio de Oncología Médica, IDIBAPS, C/Villarroel, 170, 08036 Barcelona, Spain.
Cancer Treat Rev. 2008 Dec;34(8):701-9. doi: 10.1016/j.ctrv.2008.04.002. Epub 2008 Oct 14.
The clinical decision to treat early-stage breast cancer with adjuvant chemotherapy is sometimes a difficult one because 70-80% of patients who receive chemotherapy would probably have survived without it. To help clinicians in this decision-making process, different tools or 'decision aids' have been developed for the treatment of early breast cancer over the years. Some of these tools include clinical treatment guidelines and computer-based programs as well as different prognostic and/or predictive tests such as those based on gene expression profiles or the presence minimum invasive disease. All of these tools try to individualize as much as possible the estimation of the risk of breast cancer relapse and death and to facilitate the clinical decision about giving additional treatment, and ultimately the most appropriate treatment to be given. Thus, it is important for clinicians to be aware of not only the existence of these tools or 'decision aids', but also to know how they have been developed, how frequently there are revised and if they have been validated. In order to address all these concerns, we have carried out a critical review of the most important prognostic tests and clinical guidelines for the treatment of early breast cancer. Information regarding their development process as well as frequency of revision, validations that have been performed and main limitations of each tool were gathered and critically analyzed.
对于早期乳腺癌采用辅助化疗的临床决策有时颇具难度，因为70%至80%接受化疗的患者即便不进行化疗可能也会存活下来。多年来，为协助临床医生进行这一决策过程，已开发出不同的工具或“决策辅助手段”用于早期乳腺癌的治疗。其中一些工具包括临床治疗指南、基于计算机的程序以及不同的预后和/或预测性检测，比如基于基因表达谱或存在最小侵袭性疾病的检测。所有这些工具都尽可能地力求使乳腺癌复发和死亡风险的评估个体化，并推动关于给予额外治疗以及最终给予最合适治疗的临床决策。因此，临床医生不仅要了解这些工具或“决策辅助手段”的存在，还需知晓它们是如何开发的、修订的频率以及是否经过验证，这一点很重要。为解决所有这些问题，我们对早期乳腺癌治疗中最重要的预后检测和临床指南进行了严格审查。收集并严格分析了有关它们的开发过程、修订频率、已进行的验证以及每个工具的主要局限性的信息。
