Ovarian cancer: should we be managing patients with good and bad prognostic factors in the same manner?

There are only rare circumstances where knowledge of a patient's prognostic features appropriately guides therapy. The last few years a plethora of studies have been published which attempt to refine our understanding of determinants of prognosis in ovarian cancer patients by analysing molecular markers thought to be of relevance in malignant biology. Unfortunately, only a few studies have simultaneously evaluated, in a large patient sample, the relative prognostic importance of traditional clinical pathological variables together with molecular markers through application of multivariate analysis techniques. No firm conclusions can be drawn about which markers add meaningful prognostic information to standard variables of stage, residual disease, and grade. The work on BAX (a promoter of apoptosis) in a small series of patients suggests how knowledge of the molecular attributes of certain tumours may guide treatment towards or away from certain agents. If our understanding of molecular basis of aggressive disease improves, new treatments may evolve which will turn "prognostic" indicators into "predictive" indicators, allowing selection of treatment by molecular subset.