7 – 9 Immunohistochemistry studies have yielded disappointing results, and several responsible factors have been identified. 6 Molecular analysis and protein markers are currently being investigated as a means to improve the identification of patients likely to have a poor clinical outcome and therefore more possibly benefiting from adjuvant treatment. However, CRC should be regarded as a heterogeneous, multi-pathway disease, an observation substantiated by the fact that histologically identical tumours may have neither similar prognoses nor similar response to therapy. 3 Prognostication of newly diagnosed CRC predominantly relies on stage or anatomic extent of disease based on the International Union Against Cancer (UICC-TNM) 4 and American Joint Committee on Cancer (AJCC) 5 staging classifications. 2 Despite improvements in surgical techniques, dosing and scheduling of adjuvant and neo-adjuvant therapy, the 5-year survival rate for patients with CRC ranges from 90% to 10% with tumour progression. 1 In the European Union, the incidence and mortality of CRC are 58/100 000 and 30/100 000 per year, respectively. Additionally, an approach to improve the prognostic value of immunohistochemical protein markers is proposed.Ĭolorectal cancer (CRC) is one of the most common malignancies in the western world. This article reviews the well established and additional prognostic factors in CRC and explores the contribution of molecular studies to the prognostication of patients with this disease. Randomisation of data sets, assessment of interobserver variability for protein markers and scoring systems, as well as the use of receiver operating characteristic curve analysis in combination with multimarker-phenotype analysis of several different markers may be an effective tactical approach to increase the value of immunohistochemical findings. Reliable prognostic markers identified by immunohistochemical protein profiling have yet to be established. cDNA-microarray, PCR and fluorescence in situ hybridisation are now frequently used to identity potential prognostic indicators in CRC, but the applicability of these methods in routine use is likely to have limited impact. Although several molecular features, such as LOH18q and TP53 mutation analysis, have shown promising results in terms of their prognostic value, the American Society of Clinical Oncology Tumor Markers Expert Panel does not currently recommend their use in routine practice. Evidence suggests that tumour budding and tumour border configuration are important, additional histological parameters but are not regarded as essential in prognosis. Tumour extent, lymph node status, tumour grade and the assessment of lymphatic and venous invasion are still the most important morphological prognostic factors. Prognostication of newly diagnosed colorectal cancer (CRC) predominantly relies on stage as defined by the UICC-TNM and American Joint Committee on Cancer classifications.

Protein scaffold roc curves manual