Patient Stratification [Neurosurgery Wiki]

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====== Patient Stratification ======

**Patient stratification** is the process of **categorizing patients into subgroups** based on specific biological, clinical, or molecular characteristics in order to:
  * Optimize treatment selection
  * Predict therapy response
  * Improve clinical outcomes
  * Reduce adverse effects

===== Applications =====
  * **Precision oncology**: Identifying patients with molecular alterations (e.g., EGFR mutations) for targeted therapies
  * **Clinical trials**: Selecting suitable patients for inclusion or treatment arms
  * **Risk prediction**: Estimating prognosis or likelihood of disease progression

===== Stratification Criteria =====
  * **Genetic and molecular markers**:
    * EGFR, ALK, KRAS mutations in NSCLC
    * IDH1/IDH2 mutations in gliomas
    * BRCA1/2 status in breast/ovarian cancer
  * **Tumor characteristics**:
    * Grade, stage, histology
    * Proliferation index (e.g., Ki-67)
  * **Patient-specific factors**:
    * Age, performance status
    * Comorbidities
    * Smoking history, environmental exposures

===== Example: EGFR Stratification in NSCLC =====
  * Patients with **activating EGFR mutations** (e.g., exon 19 deletion, L858R) are eligible for [[oncology:egfr_tki|EGFR-TKI therapy]].
  * Patients with **T790M mutation** post-resistance may benefit from third-generation TKIs like [[oncology:osimertinib|Osimertinib]].

===== Benefits =====
  * Avoids over-treatment or under-treatment
  * Enhances **efficacy** of targeted therapies
  * Enables **cost-effective** healthcare delivery
  * Supports **personalized medicine**

===== Related Topics =====
  * [[oncology:biomarkers|Biomarkers]]
  * [[oncology:precision_medicine|Precision Medicine]]
  * [[oncology:companion_diagnostics|Companion Diagnostics]]
  * [[oncology:clinical_trials|Clinical Trial Design]]