Neue prognostische und prädiktive Faktoren beim Mammakarzinom

Kernaussagen

Für Patientinnen mit Mammakarzinom haben Fortschritte bei der Früherkennung und der postoperative Einsatz medikamentöser adjuvanter Therapien das Überleben in der nodal-positiven sowie in der nodal-negativen Situation verbessert.

Für die Auswahl der geeigneten adjuvanten Therapiestrategie muss eine individuelle Risikoabschätzung erfolgen. Wichtigster pathologischer Risikofaktor ist dabei der axilläre Nodalstatus. Für nodal-negative Patientinnen gibt es zur Risikoklassifikation jedoch ebenfalls zusätzliche prognostische und prädiktive Faktoren sowie Analysealgorithmen zur Risikoberechnung. Letztere umfassen das internetbasierte System Adjuvant! und Multiparameter-Genexpressionsanalysen (70-Gene-Signatur, Recurrence-Score).

Prognostische Faktoren schätzen die Prognose ohne spezielle Berücksichtigung einer adjuvanten medikamentösen Therapie ab, während prädiktive Faktoren dazu dienen, die Prognose unter Berücksichtigung einer speziellen adjuvanten Therapie abzuschätzen. Zu den derzeit am besten untersuchten molekularen Tumormarkern gehören ER, Ki-67, HER-2, TOP2A, EpCAM, uPA / PAI-1. Sie haben z. T. prognostische, aber z. T. auch prädiktive Bedeutung für die Entscheidung der geeigneten adjuvanten Therapie.

Die derzeit laufende MINDACT-Studie untersucht und vergleicht prospektiv das Risikoprofil sowohl durch klinisch-pathologische Risikoabschätzungen mit Adjuvant! als auch durch Analysen der 70-Gene-Signatur.

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