I have posted a number of previous notes about the need for pathologists to provide more scientific assessments of disease prognosis (i.e., disease outcome) within surgical pathology reports (see: Assessing Disease Prognosis in Pathology and Lab Medicine; Expanding the Definition of the Early Health Model). I believe that this can be ultimately accomplished by the assessment of serum and tissue biomarkers but this approach is not highly developed at this time. A recent article (see: Predicting Outcomes For Stomach Cancer Patients) addresses this specific topic and caught my attention. Below is an excerpt from it:
According to [a recent] study..., patients who had poor outcomes following surgery for stomach cancer also had extremely low amounts of two proteins, known as gastrokine 1 and 2 (GKN1 and GKN2), which are produced by normal stomach cells. The study's findings confirm previous research showing that once stomach cells become cancerous, they manufacture very low amounts of GKN1 and GKN2. However, this is the first known study to link these low protein levels with outcomes following stomach cancer surgery....[The lead author of the paper], an expert on H.pylori, and colleagues initially set out to learn more about what the bacterium does to normal stomach cells. They focused on GKN1 and GKN2 because these proteins are also suppressed by stomach infections caused by H. pylori. After looking at tissue samples from more than 150 stomach cancer patients who underwent surgery, the researchers discovered a near total suppression of GKN1 and GKN2 in the majority of patients. This was particularly evident in those patients with the diffuse variant of stomach cancer. More than three-quarters of these patients had extremely low levels of GKN1 and 85 percent had nearly nonexistent levels of GKN2. Furthermore, in those patients with the intestinal variant of stomach cancer, very low levels of GKN 1 or GKN 2 at the time of surgery were associated with a significantly worse outcome.
This report provides a fascinating view of the use of biomarkers to assess the prognosis of gastric cancer. However, the lessons are probably not generalizable to other tumors because of the etiologic linkage of H. pylori to the gastric cancer. Nevertheless, this study is a step in the right direction by beginning to link biomarker titers to prognosis for malignant disease. As I remarked in my blog note cited above, the assessment of prognosis by pathologists has largely been ignored because there has not been an objective basis for doing so other than survival data. A small portion from that note is worth repeating:
It's not too hard to come up with a rationale for ignoring prognosis. The emphasis in healthcare has traditionally been on diagnosis and treatment of disease, perhaps because these topics have been paramount in the minds of the care providers. However, any physician who has been a patient or who has great empathy for the concerns of patients, understands that the prognosis of a disease, particularly those with serious consequences, looms very large in the minds of patients and their families.
It now appears that a scientific basis for commenting on the outcome of at least one malignant lesion is beginning to emerge.
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