Steineck G, Adolfsson J, Scher H I, Whitmore W F
Department of Cancer-Epidemiology and Oncology, Radiumhemmet, Stockholm, Sweden.
Urology. 1995 Apr;45(4):610-5. doi: 10.1016/S0090-4295(99)80052-1.
To distinguish the concepts of prognostic and treatment-predictive information for localized prostate cancer.
We defined a prognostic factor as one that identifies subgroups associated with differing outcomes in untreated patients. A treatment-predictive factor identifies patients with differing outcomes as a consequence of treatment and is best identified in a large, randomized trial. Outside of such a trial, a treatment-predictive factor can be identified in prognostic subgroups or after adjustment for prognostic factors.
The distinctions between prognostic and treatment-predictive factors are illustrated by hypothetical examples.
The practical implication of the distinctions is that prognostic information may not provide reliable treatment-predictive information, that is, additional information may be needed before selection of patients for different treatments can be based on prognostic information. Determination of the relative treatment effect in any prognostic subgroup of patients requires a comparative setting. Until now, identified prognostic factors for localized prostate cancer at best can give guidance for clinical decisions on which patients should not be offered local aggressive therapy if the aim of the therapy is to cure the patient of the disease.
区分局限性前列腺癌预后信息和治疗预测信息的概念。
我们将预后因素定义为一种能识别未接受治疗患者中与不同预后相关亚组的因素。治疗预测因素则是识别因治疗而有不同预后的患者，并且最好在大型随机试验中确定。在此类试验之外，可在预后亚组中或在对预后因素进行调整后识别治疗预测因素。
通过假设示例说明了预后因素和治疗预测因素之间的区别。
这些区别的实际意义在于，预后信息可能无法提供可靠的治疗预测信息，也就是说，在基于预后信息为不同治疗选择患者之前，可能需要额外的信息。确定任何患者预后亚组中的相对治疗效果需要进行比较。到目前为止，已确定的局限性前列腺癌预后因素充其量只能为临床决策提供指导，即如果治疗目的是治愈疾病，哪些患者不应接受局部积极治疗。
