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Annals of Oncology Advance Access published online on June 24, 2005
Annals of Oncology, doi:10.1093/annonc/mdi352
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© 2005 European Society for Medical Oncology
Received January 18, 2005
Revised April 11, 2005
Accepted April 12, 2005

Review

Proliferative markers as prognostic and predictive tools in early breast cancer: where are we now?

M. Colozza 1, E. Azambuja 2, F. Cardoso 3, C. Sotiriou 3, D. Larsimont 4, and M. J. Piccart 3*

1 S. C. Oncologia Medica, Azienda Ospedaliera, San Sisto 06132 Perugia, Italy
2 Medical Oncology Clinic, Jules Bordet Institute, Boulevard de Waterloo, 125, 1000 Brussels, Belgium
3 Medical Oncology Clinic, Jules Bordet Institute, Boulevard de Waterloo, 125, 1000 Brussels, Belgium; Translational Research Unit, Jules Bordet Institute, Boulevard de Waterloo, 125, 1000 Brussels, Belgium
4 Translational Research Unit, Jules Bordet Institute, Boulevard de Waterloo, 125, 1000 Brussels, Belgium; Department of Pathology, Jules Bordet Institute, Boulevard de Waterloo, 125, 1000 Brussels, Belgium

* To whom correspondence should be addressed.
M. J. Piccart, E-mail: martine.piccart{at}bordet.be


  Abstract

In the last few decades, proliferative markers have been broadly evaluated as prognostic and predictive factors for early stage breast cancer patients. Several papers evaluating one or more markers have been published, often with contradictory results. As a consequence, there is still uncertainty about the role of these proliferative markers. The present paper critically reviews the current knowledge about the following markers: thymidine labeling index, S phase fraction/flow cytometry, Ki 67, thymidine kinase (TK), cyclins E, cyclin D, the cyclin inhibitors p27 and p21, and topoisomerase II{alpha}. For each marker, the prognostic and predictive role was separately analyzed. Only papers published in English in peer-reviewed journals before June 2004 that include at least 100 evaluable patients were selected. In addition, the prognostic and predictive role of the proliferative markers had to be assessed through multivariate analyses. One hundred and thirty-two papers fulfilled these criteria and 159 516 patients were analyzed. Unfortunately, several methodological problems in the research to date prevent us from including any one of these proliferative markers among the standard prognostic and predictive factors. Early incorporation of translational research and new technologies with clinical trials are needed to prospectively validate biological markers and allow their use in clinical practice.

Keywords: breast cancer; proliferative markers; prognostic markers; predictive markers.
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