Children with a high risk classification require prompt emergency treatment and management.
The combination of positivity for cyclin H and high risk classification predicts highly significant poor prognosis in GIST.
Our data suggest that, in addition to high risk classification, cyclin H expression might be an indicator for "very-high risk" GIST.
A combination of cyclin H expression level and high risk classification yielded the strongest prognostic indicator for disease-specific and disease-free survival (p ≤ 0.001).
High risk classification according to Fletcher et al. [ 1] is a reliable predictor for the development of metastases or tumour relapse since 85-97% of the affected patients originate from the high risk group.
Moreover, with regard to the whole population, the combination of cyclin H positivity and high risk classification according to Fletcher was strongly predictive of a poor DFS as well as DSS (p = 0.001 and p < 0.001) [ 1].
Thus for both men and women, the mean predicted risks in patients reclassified from high to low risk (and vice versa) with QRISK2 were more accurate compared with the mean observed risk than mean predicted risks with NICE Framingham (see online appendix for low, intermediate, and high risk classification).
The Kaplan Meier plots for the hormone receptor positive patients without a pCR, stratified by four of the molecular signatures, and by clinical stage, showed that the low risk classification identified patients with a much better outcome than the high risk classification (Fig. 2).
What remains uncertain is whether the large number of patients who move to higher risk classifications also benefit from OAC.
In the comparison between prophylaxis with tamoxifen vs no prophylaxis (Table 4), cost savings are estimated in higher risk classifications, among women with a history of LCIS or AH, starting at younger age.
In the comparison between prophylaxis with tamoxifen vs no prophylaxis, favourable results, that is 'cost less and gain more' or cost-effective, are obtained in higher risk classifications starting at younger age.
