[Commentary on development of the prognostic factors concept in chronic lymphocytic leukaemia: the route from prognostic factors to therapy response predictors]. / Komentár k vývoju konceptu prognostických faktorov chronickej lymfocytovej leukémie: cesta od prognostických faktorov k prediktorom liecebnej odpovede.

Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder with variable clinical course. Determination of disease prognosis is based on the identification of different prognostic factors. The concept of CLL prognostic factors is still developing and has undergone several fundamental changes. Traditional (old) prognostic factors and staging systems are useful in describing the extent of the disease at any given moment, in determining clinical progression and in the identification of patients who need to start treatment. However, traditional prognostic factors are not sufficient for predicting a long-term prognosis because they are not able to identify potentially aggressive forms of CLL in the early stages. Nevertheless, clinical staging systems maintain their importance and in contrast to other traditional factors also their independent prognostic role. Otherwise, traditional prognostic factors play the role of disease activity descriptors rather than the role of actual prognostic factors. CLL risk profile determination is based on the identification of so-called new prognostic factors, the most relevant of which are chromosomal aberrations, TP53 gene mutations, mutational status of IgVH genes, ZAP-70 and CD38 expression. These factors are able to predict the prognosis already at the time of the initial diagnosis. In contrast to previous ideas, they are not incorporated into recommendations regarding indications for treatment. This is due to the risks associated with early treatment and the lack of data validated in prospective clinical trials demonstrating the justifiability of such procedure. In patients being treated, new prognostic factors may be useful for predicting the response to the therapy and some of them may directly influence the choice of treatment regime. New CLL treatment modalities have also raised the question of their influence on the prognostic and predictive power of new prognostic factors.

Scoring index for prediction of HER-2 status in the invasive breast carcinoma.

OBJECTIVE: Detection of HER-2 status represents conditio sine qua non for appropriate therapeutic management of patients with invasive breast carcinoma (IBC). We aimed to modify a DIVER scoring index (sec. Taucher et al., 2003) used for the assessment of HER-2 status probability in IBCs. METHODS: 660 cases of IBC with determined HER-2, estrogen (ER) and progesterone (PR) receptor status and histologic grade (HG) were included in the study. The HER-2, ER and PR were examined immunohistochemically. Cases showing an HER-2 score of 2+ (n = 38) were further tested by chromogenic in situ hybridisation to confirm or exclude HER-2 gene amplification. Based on the correlation of HER-2 with HG, ER, and PR a score index (HERSI) was designed to set a probability score for evaluation of HER-2 status. This index summarizes the individual score of HG, ER, and PR as follows: HG1 = 2 points, HG2 = 1 point, HG3 = 0 points; a negative ER or PR status = 0 points, a positive ER, or PR status 50% of the cells = 2 points. In regard to the final score (0-6 points), cases were divided into subgroups. RESULTS: HER-2 status was positive in 80 cases (12.1%). A statistically significant correlation between HER-2 and HG, ER, PR status was proven (p < 0.0001). In the subgroup with an HERSI score of zero, HER-2 positive status was found in 30.9%, while in the subgroup with an HERSI score of 5-6 points in only 1.2% of cases. The probability of a positive HER-2 status for cases with a score of 1-4 was approximately 25% (OR = 0.255; CI = 0.155-0.421) and for cases with a score of 5-6 only 2.6% (OR = 0.026; CI = 0.006-0.111) in comparison to the control group. CONCLUSION: The proposed scoring index allows significant prediction of HER-2 status in IBCs.