Cell-Cycle analysis

From: larry_seamer@bio-rad.com
Date: Tue Sep 16 1997 - 12:58:07 EST


     
     An Open Letter to the flow  cytometry community:
     
     I have spent a good deal of my career studying and developing flow 
     cytometric cell-cycle analysis. Approximately a year ago, a panel of 
     unnamed scientists commissioned by ASCO published a recommendation 
     that flow cytometry NOT be performed on breast or colorectal tumors in 
     a clinical setting (Journal of Clinical Oncology, 1996;14:2843-77). 
     
     Using ASCO's own statistics on papers dealing with colorectal cancer 
     from the last 8 years, 24 of 31 studies found ploidy to be prognostic 
     in colorectal cancers. In 13 of 17 studies where the question was 
     asked, ploidy was found to be an INDEPENDENT prognostic indicator. 4 
     of 7 papers found S-Phase to have prognostic significance 3 of those 
     determined S-Phase to be an INDEPENDENT indicator.
     
     Their report was much more vague when reporting the outcome of the  
     breast cancer literature search. However the panel did note that the 
     majority of studies show S-Phase to have independent value in some 
     patient subsets. The author's complaint here was that the studies were 
     retrospective and used different cut-points for high vs. low S-Phase. 
     The panel also noted that MANY studies had found INDEPENDENT 
     prognostic value to S-Phase determination in axillary node negative 
     patients. However they expressed the same concerns as previously 
     noted.
     
     Most of the findings in this report are positive and the negative 
     recommendation is not deserved. It is my concern that the 
     recommendations in this report are being taken on face value without 
     regard to the underlying findings of the panel. Many of the concerns 
     expressed can be overcome with more stringent standardization and 
     further prospective studies. Because of the bottom-line negative 
     recommendations, this report is having a chilling effect on the 
     oncology community, probably preventing the very studies that the 
     panel is looking for.
     
     We, in the flow cytometry community, have an obligation to counter 
     this negative bias with sound data. It is ultimately the cancer 
     patient that suffers when independent prognostic information is 
     withheld from their clinician. I am afraid that is exactly what is 
     happening as a result of this report. 
     
     However, there is still time to act. First, we need to get real 
     standardization. Second, the Consensus Committee report from 1993 
     needs to be revisited and strengthened. Further, We need to talk to 
     oncologist to present the data that is already in the literature. 
     
     If we remain passive our potential contribution to the wellness of 
     these patients will go unused. 



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