Prognostic factors in gynecological tumors and breast cancer

Prognostic and predictive factors at primary diagnosis of breast cancer or in the metastatic setting can support decision making for an individualized therapy. Prognosis describes the risk of disease recurrence or risk of disease-related death. Of the many prognostic tests available, clinical-pathological factors (tumor size, nodal status, hormone receptor status, grading, lymphatic vessel invasion and circulating tumor cells) are well validated. New multigene assays can also provide a good prognostic evaluation, but are not well validated as predictive markers. A combination of clinical-pathological factors, protein tests and new multigene assays could be useful, especially in patients with intermediate risk, where decision making for adjuvant chemotherapy is difficult. Regarding ovarian cancer, the clinical-pathologic factors (tumor stage, residual disease, grading, age and performance status) are important. Especially in patients with platinum-sensitive recurrent disease BRCA mutation status defines whether these patients benefit from PARP inhibitors. The prognosis of endometrial carcinomas is stratified according to histological subtype. In the future, it will be important to establish mutational analyses and multigene assays to optimize treatment for gynecological tumors.