Host defense factors, tumor aggressiveness, and prognosis associated with carcinomas of the breast

Analysis of disease-free survival rates in 405 women with operable breast cancers was undertaken in a five-year retrospective study; tumor aggressiveness and host defense factors ( HDF ) were evaluated by a histologic method. Tumors were classified as slightly, moderately, or highly aggressive carcinomas by a scoring method that takes into account several histologic features. The presence of absence of HDF was determined by nodal sinus histiocytosis in the regional axillary lymph nodes and by stromal mononuclear reaction in the primary tumor. Overall, women with positive HDF had better cumulative five-year survival rates (76 per cent) than women with negative HDF (49 per cent). The combination of highly aggressive tumors, metastatic lymph nodes, and negative HDF was associated with extremely poor five-year survival rates (1 per cent) compared with those observed for women with aggressive tumors, nodal metastases, and positive HDF (30 percent), P less than 0.001. In this group, patients with four or fewer metastatic nodes showed a recurrence rate of 28 per cent; however, if five or more nodes were involved, the recurrence rate was 93 per cent. This pattern in disease-free survival rates related to HDF was not found in slightly or moderately aggressive tumors with or without metastases or in aggressive tumors without metastases. In addition, there was no relation between the number of metastatic nodes and survival in patients with slightly or moderately aggressive tumors or with aggressive tumors and negative HDF . It is concluded that HDF influence survival only in aggressive tumors with metastases and that the inherent aggressiveness of the tumor is the main factor that determines prognosis.