Factores Pronosticos En Cancer De Colon

Prognostic Factors in Colorectal Cancer
College of American Pathologists Consensus Statement 1999
Carolyn C. Compton, MD, PhD; L. Peter Fielding, MD; Lawrence J. Burgart, MD; Barbara Conley, MD; Harry S. Cooper, MD; Stanley R. Hamilton, MD; M. Elizabeth H. Hammond, MD; Donald E. Henson, MD; Robert V. P. Hutter, MD; Raymond B. Nagle, MD, PhD; Mary L. Nielsen, MD; Daniel J. Sargent, PhD; Clive R.Taylor, MD, PhD; Mark Welton, MD; Christopher Willett, MD

● Background.—Under the auspices of the College of American Pathologists, the current state of knowledge regarding pathologic prognostic factors (factors linked to outcome) and predictive factors (factors predicting response to therapy) in colorectal carcinoma was evaluated. A multidisciplinary group of clinical (including thedisciplines of medical oncology, surgical oncology, and radiation oncology), pathologic, and statistical experts in colorectal cancer reviewed all relevant medical literature and stratified the reported prognostic factors into categories that reflected the strength of the published evidence demonstrating their prognostic value. Accordingly, the following categories of prognostic factors were defined. CategoryI includes factors definitively proven to be of prognostic import based on evidence from multiple statistically robust published trials and generally used in patient management. Category IIA includes factors extensively studied biologically and/or clinically and repeatedly shown to have prognostic value for outcome and/or predictive value for therapy that is of sufficient import to be included inthe pathology report but that remains to be validated in statistically robust studies. Category IIB includes factors shown to be promising in multiple studies but lacking sufficient data for inclusion in category I or IIA. Category III includes factors not yet sufficiently studied to determine their prognostic value. Category IV includes factors well studied and shown to have no prognosticsignificance. Materials and Methods.—The medical literature was critically reviewed, and the analysis revealed specific
Accepted for publication December 17, 1999. From the Massachusetts General Hospital, Boston (Drs Compton and Willett); York Hospital, York, Pa (Dr Fielding); Mayo Clinic, Rochester, Minn (Drs Burgart and Sargent); National Cancer Institute, Bethesda, Md (Drs Conley and Henson); Fox ChaseCancer Center, Philadelphia, Pa (Dr Cooper); M. D. Anderson Cancer Center, Houston, Tex (Dr Hamilton); LDS Hospital, Salt Lake City, Utah (Dr Hammond); St Barnabas Medical Center, Livingston, NJ (Dr Hutter); University of Arizona, Tucson (Dr Nagle); Kansas Pathology Consultants, Wichita, Kan (Dr Nielsen); University of Southern California, Los Angeles (Dr Taylor); and University of California, SanFrancisco (Dr Welton). Presented at the College of American Pathologists Conference XXXV: Solid Tumor Prognostic Factors: Which, How and So What?, Chicago, Ill, June 10–13, 1999. Reprints: Carolyn C. Compton, MD, PhD, Department of Pathology, Warren Building, Room 256, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114. Arch Pathol Lab Med—Vol 124, July 2000

points of variability inapproach that prevented direct comparisons among published studies and compromised the quality of the collective data. Categories of variability recognized included the following: (1) methods of analysis, (2) interpretation of findings, (3) reporting of data, and (4) statistical evaluation. Additional points of variability within these categories were defined from the collective experience of thegroup. Reasons for the assignment of an individual prognostic factor to category I, II, III, or IV (categories defined by the level of scientific validation) were outlined with reference to the specific types of variability associated with the supportive data. For each factor and category of variability related to that factor, detailed recommendations for improvement were made. The recommendations...