Conclusion

The ability to refine prognoses on the basis of clinical parameters has been largely maximized. With the possible exception of dynamic determination of marker decline, it is unlikely that readily available clinical data will contribute significantly to newer or better prognostic systems. The advent of molecular oncology and the ability to perform biologic assessments of these fascinating tumors open the door to investigations of markers of proliferation, apoptosis, and gene expression as newer, more precise, and more therapeutically relevant end points. The same large cooperative efforts that led to the IGCCC system with clinical parameters may be required to validate these unfolding biologic parameters.

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