College of American Pathologists Conference XXXV: Solid tumor prognostic factors - Which, how and so what? Summary document and recommendations for implementation

The College of American Pathologists convened a prognostic factor conferenc e in tune 1999 to consider prognostic and predictive factors in breast, col on, and prostate cancer, and to stratify these factors into categories refl ecting the strength of published evidence. Because so little progress in pr ognostic factor clinical utility has been made in the last 5 years, the con ference participants focused their attention on decreasing variation in met hods, interpretation, and reporting of these factors so that greater clarit y of value could be achieved. The conference was organized to promote discu ssion, broad input, and future planning. An initial plenary session provide d an overview of the status of tumor marker research, the impact of variati on in medicine and pathology, and statistical issues related to prognostic factor research. In working group sessions for each cancer type, participan ts interactively evaluated and refined the documents created by the expert panels. A second plenary session dealt with issues common to all 3 groups, including the problem of micrometastases in lymph nodes in these sites; sta tistical issues that arose during the breakout discussions; and issues of v ariation in methods, interpretation, and reporting of immunohistochemical a ssays. A faculty session brainstormed strategies that could be used to impl ement the changes recommended. This session included invited representative s of the Food and Drug Administration, Health Care Financing Administration , Centers for Disease Control and Prevention, National Cancer Institute, Am erican Joint Committee on Cancer, and International Union Against Cancer. C ancer site and general recommendations were presented and discussed during a final session to achieve consensus of the conference participants and to address feasibility of implementation of these recommendations. A final dis cussion focused on future initiatives that might lead to implementation of the changes proposed in the conference by the various organizations represe nted. This report summarizes the general conference recommendations, cancer working group recommendations, and plans for implementation of the recomme ndations.