Then predictive is, “What’s the chance that an intervention we do-X, Y, or Z, whatever it is-works vs does not work?” What are the tests that can tell us that? Sometimes, the tests are the same: Some can be both prognostic and predictive. But for the clinical features, in general what we’re trying to say with prognostic is, “What is the chance that the cancer could come back?” That’s really all that says. Vijayakrishna Gadi, MD, PhD: Today we’re going to talk about tests and how we use those tests. What is the difference between a predictive and a prognostic factor? Kristie Kahl: You went over a bunch of different types of factors. So, it wasn’t completely accurate for us. They were able to say that this group could be at more of a risk than this group, but there were certainly people with high-risk features who did not recur, and there were low-risk features of their initial presentation who did recur. The problem with those prognostications was that they were not necessarily very precise. If your grade was high vs low, you were more likely to recur. If you had node positive vs node negative, you were more likely to recur. For example, if you had a larger tumor as opposed to a smaller tumor, you could recur, and you were more likely to recur. Any clinical factor that was worse for a patient was prognostic for a recurrence. They monitored those patients, where they set all those patients back at 0-in terms of them having not recurred-and then monitored them at 5-year intervals to see the things that predicted patients would recur. They looked at tens of thousands of patients who had been treated for early stage breast cancer and then discontinued their antiestrogen therapies at 5 years. There was a paper not too long ago by Pan and colleagues that was published in the New England Journal of Medicine. Those are typical pathologic clinical factors that any oncologist and any surgical oncologist who has treated the patient can potentially give us, and we can plug those things into a variety of tools, like calculators, to then say, what is the chance that this cancer could come back in the fifth year and beyond? Also, how much in terms of the stage of the tumor itself in the breast, whether it was T1, T2, T3, for example, but also the involvement of the lymph nodes, and the degree of involvement, with N0, N1, N2 designations. Conventionally, the tools we had were what the cancer told us, the face value-how much there was at the time of diagnosis, how mean it looked, things like grade 1, 2, and 3. Vijayakrishna Gadi, MD, PhD: This is more complicated. Kristie Kahl: What do we know about which patients might benefit from extended adjuvant therapy and which patients might not?
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