Prognostic Factors in Cancer

	reviewed in: Archives of Pathology & Laboratory Medicine Vol. 126, No. 3, March 2002

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Prognostic Factors in Cancer, second edition, is a concise and accessible compendium of essential information, abstracted from an enormous body of medical and scientific literature, about determinants of outcome in malignant disease. It is a distillation of the long-term efforts of the International Union Against Cancer to define those determinants from existing data and to put them into a framework that is relevant to clinical practice. Notwithstanding the incontrovertible data that extent of disease and histologic type of tumor are generally the most important indicators of outcome, broad overlap in outcomes of patients with tumors of like stage and type exist. Thus, the search for additional tumor-, site-, and patient-specific factors that can provide more accurate prediction of outcome and aid in clinical management of patients has been intense. This search has been fruitful but has generated an overwhelming volume of data. For the practicing pathologist assessing cancer specimens, such data are critically important, but the task of tracking and analyzing this rapidly expanding body of data is beyond the capabilities of most.

This 800-page paperback volume organizes and summarizes current knowledge about prognostic factors in each major tumor site by topic and relevance. It does so in a manner that is straightforward and very user friendly, even for those completely uninitiated in this field. It also contains an excellent introductory section that deals with general principles of prognostic factor assessment, classification, measurement, and statistical analysis and of application to clinical decision-making and research.

The site-specific sections cover the entire range of major cancer sites, including the brain, as well as cancer types, including both solid and liquid tumors. Concise epidemiologic summaries are provided. All relevant tumor-related and host-related factors are discussed and are organized in context of the strength of existing data. References are comprehensive and cited in the text. All chapters are heavily supplemented with helpful graphic presentations of information, and each ends with an appendix of summary tables that provide an at-a-glance summary of the factors discussed, stratifying them into 3 levels of import of validation: essential, additional, and new and promising. The book ends with a glossary of terms, common and specialized, that are frequently used (and not infrequently used incorrectly) in the field of prognostic factors.

In summary, this book is a must-have for pathologists involved either in cancer diagnosis or cancer research. The multifaceted, multidisciplinary approach and the concise but comprehensive organization of Prognostic Factors in Cancer make it uniquely valuable to pathologists involved in the care of cancer patients. The book begins with a quote from Sir William Osler, once the chairman of the pathology department at McGill University: “Medicine is a science of uncertainty and an art of probability.” These words are especially applicable to cancer medicine, but it is fair to say that Prognostic Factors in Cancer does its part to help decrease the uncertainty.