影响乳腺癌术后局部复发因素的分析

选择主要临床与组织病理学因素和治疗因素，观察对乳腺癌术后局部复发的影响，２４２２例女性浸润性乳腺癌病人中，３年内局部复发１８２例，复发率７．５％，经过Ｌｏｇｉｓｔｉｃ回归的方法统计，年龄，绝经状态和病理类型不是影响乳腺癌术后局部复发的主要因素，而原发肿块情况，腋下淋巴结转移与否和雌激素受体状态对乳腺癌术后的局部复发的影响有意义，尤以肿块侵犯皮肤或胸壁，腋下淋巴结转移融合，雌激素受体阴性者术后复发的     

乳腺癌临床特征与预后分析

目的：总结经综合治疗的233例乳腺癌患者的临床病理特征及生存情况,探讨影响乳腺癌预后的因素。方法：建立乳腺癌患者的临床资料库,采用SPSS8.0统计软件对临床数据进行单因素及多因素生存分析,以发现影响乳腺癌长期生存的因素。结果：所有患者1、2、3、5和8年生存率分别为95.71%（223/233）、82.83%（193/233）、61.37%（143/233）、37.34%（87/233）和6.87%（16/233）。单因素分析显示腋淋巴结转移数目;原发肿瘤大小与生存呈负相关（P均〈0.001）;TNM晚期患者复发转移的患者中位生存明显缩短（P均〈0.0001）;术后辅助化疗方案选择含有蒽环类的方案组生存期优于不含有蒽环类的方案组（P〈0.05,X^2=9.99）;病理类型治疗方式与生存时间相关（P均〈0.01）。COX比例风险模型分析显示治疗方式、术后辅助性化疗方案和复发转移具有独立预后意义（P〈0.05）。Logistic分析结果显示,原发肿瘤大小、腋窝淋巴结转移状态、病理类型、综合治疗方式是影响乳腺癌复发转移的主要因素,其影响程度的排序依次是腋窝淋巴结转移、原发肿瘤大小、病理类型、综合治疗方式（P〈0.0001）。结论：乳腺癌患者的远期生存及复发转移与原发肿瘤大小、腋窝淋巴结转移状态、病理类型、术后化疗方案的选择及个体化综合治疗方式密切相关。     

乳腺癌患者术后不同部位复发转移的风险分布

背景与目的:乳腺癌患者术后有其常见的转移部位,有研究认为乳腺癌的转移是呈一定的时间规律分布,然而各不同部位的转移规律及相互关系则鲜有报道.本研究旨在探讨复发的风险规律以及其在不同部位间差异.方法:回顾性分析2005年1月-2007年5月在我院乳腺科专家门诊连续接诊的手术后复发或转移的210例患者,分析局部复发、远处转移,以及淋巴结、骨、肝、肺等不同转移部位的年复发风险时间分布.复发风险采用Cox风险函数估计,并运用Kernel平滑曲线作图.结果:根据乳腺癌预后因子进行分层分析发现乳腺癌患者术后的年事件风险曲线呈双峰模式,术后第2.5年和第9年高危复发者双峰风险高度显著高于中低危患者.局部复发与远处转移的年事件风险亦呈现双峰型模式,局部复发的风险曲线双峰出现均分别早于远处转移2～3年.淋巴结、骨、肺、肝等部位转移的双峰出现的事件基本一致,但均晚于局部复发时间.结论:乳腺癌患者术后不同部位转移均存在一定的时间分布规律,局部复发和内脏转移的主要机制可能有所不同,前者可能是后者的先兆,应特别注意中高危患者的局部复发征象.     

乳腺癌保留乳房治疗局部复发风险因素回顾性分析

目的:探讨早期乳腺癌保留乳房术后局部复发的临床病理危险因素。方法:收集我院1998-09-01-2011-07-31收治的临床0～Ⅱ期行保留乳房手术的146例早期乳腺癌患者的病例资料,采用Cox检验对患者年龄、肿瘤大小、淋巴结状态、雌激素受体(ER)表达、孕激素受体(PR)表达、人类表皮生长因子受体2(HER-2)表达和分子分型与术后局部复发的相关性进行单因素和多因素分析。结果:中位随访61个月,9例患者首发出现患侧乳房局部复发,生存分析显示3年和5年累积局部复发率分别为6.3%和7.5%。患者年龄、肿瘤大小、ER/PR表达状态和分子分型与术后局部复发无明显相关性,P>0.05。HER-2阳性(P=0.002 1)和淋巴结阳性(P=0.03)与局部复发有相关性,且是独立影响因素。结论:HER-2阳性和淋巴结阳性是乳腺癌保留乳房术后局部复发的独立预后高危因素,而患者年龄、肿瘤大小、激素受体表达状态和局部复发无显著相关性。     

复发性乳腺癌预后分析

根据４０２例乳腺癌术后复发患者的临床回顾性分析的资料，探讨影响乳腺癌术后复发转移的预后因素及其改善疗效的途径。分析结果表明，６０％的乳腺癌复发患者在复发后２年内死亡。乳腺癌复发患者复发后的２年生存率与患者的年龄、月经状况、雌激素受体与孕酮受体状况、手术方式、预防或治疗性去势无关，与首发部位、原发肿瘤分期、肿瘤大小、手术时淋巴结转移数、复发后治疗情况及无复发间期长短有关。文章指出重视手术操作，合理安排术后治疗及加强术后患者的随诊，力求改善疗效。     

腋窝淋巴结转移对初次保乳手术乳腺癌患者预后的影响

目的 探讨腋窝淋巴结转移对初次保乳手术乳腺癌患者预后的影响。方法 选取75例初次保乳手术后复发乳腺癌患者作为研究对象，依据术前腋窝淋巴结状态分为阳性组(32例)及阴性组(43例)。所有患者均行保乳手术+腋窝淋巴结清扫术治疗，比较两组局部区域复发情况、临床病理特征，并分析远处转移、生存情况及复发的影响因素。结果 两组局部复发、区域复发及局部+区域复发率相比，差异无统计学意义(P>0.05);75例患者共45例发生远处转移(60.00%),阳性组远处转移率为78.13%(25/32),高于阴性组的46.51%(20/43),有统计学差异(P<0.05);生存分析显示，复发后3年生存率为57.33%(43/75),复发后5年生存率为38.67%(29/75);阳性组复发后总生存率较阴性组低，有统计学差异(P<0.05);多因素分析显示：复发部位、腋窝淋巴结状态为复发患者总生存的独立影响因素(P<0.05)。结论 腋窝淋巴结转移可影响初次保乳手术乳腺癌患者预后，能降低术后生存率，缩短患者总生存时间，增加复发后远处转移风险。     

影响中国华北地区女性乳腺癌无病生存期的临床病理因素——多中心回顾性研究

摘 要：［目的］ 探讨华北地区乳腺癌术后复发不同时间间隔与临床病理特征的相关性。［方法］ 对华北地区3家医院2012年1月1日至2014年12月31日收治的术后复发转移的乳腺癌病例资料进行分析,分析影响近期复发和远期复发患者的临床病理特征、复发转移规律和特点。［结果］ 696例乳腺癌术后复发患者纳入研究,平均年龄为45.28岁,其中394例患者3年内发生复发转移（56.6%）,3年以上复发转移患者共302例（43.4%）。本研究发现近期复发患者（DFS<36个月）具有初诊年龄低、淋巴结转移≥4个、肿瘤直径>2cm、雌孕激素受体阴性、HER-2阳性、辅助化疗和辅助内分泌治疗的特点;多因素分析显示,淋巴结转移数、术后辅助化疗及内分泌治疗是复发转移间隔时间的独立影响因素。［结论］ 淋巴结转移数≥4个、雌激素、孕激素受体阴性、HER-2表达阳性、术后未进行辅助化疗、内分泌治疗是乳腺癌术后发生早期复发的危险因素,应进行密切随访。     

乳腺癌改良根治术患者术后复发转移的多因素分析

目的:探讨107例乳腺癌患者改良根治术后复发及远处转移的影响因素,为乳腺癌预防及治疗提供理论基础。方法:对2010年1月至2015年1月我院收治的乳腺癌患者术后的临床资料进行回顾性分析,将107例患者分成复发转移组(34例)及非复发转移组(73例),分析各临床病理因素与乳腺癌患者术后复发转移的关系。结果:乳腺癌患者年龄、肿瘤大小、病理类型、腋窝淋巴结转移、激素受体、TAMs、VEGF、MVD、p53蛋白表达、化疗方案、脉管癌栓、S-TK1、S-CD105、GLUT-1及HK-II与术后复发转移密切相关,差异有显著性(P<0.05),而绝经情况与术后复发转移无明显相关,差异无统计学意义(P>0.05);Logistic多因素回归结果表明,年龄、原发肿瘤大小、p53蛋白表达、S-TK1表达是乳腺癌患者复发转移的独立危险因素。结论:年龄、原发肿瘤大小、p53蛋白表达、S-TK1表达与乳腺癌复发转移密切相关,针对影响乳腺癌复发转移的因素,进行综合的预防及治疗,可以降低乳腺癌患者复发转移的风险,提高生存率。     

乳腺癌患者术后胸壁复发及预后相关因素分析

目的 乳腺癌出现胸壁复发通常被认为是乳腺癌治疗失败的第一征象,是发生远处转移的先兆.本研究回顾性分析乳腺癌术后胸壁复发患者病例资料,分析影响乳腺癌患者术后胸壁复发及预后的相关因素,为规范的临床治疗提供有用的依据.方法 收集湖南省肿瘤医院2008-01-01-2009 12-31收治的130例乳腺癌术后胸壁复发患者的临床、病理及预后资料,其中Ⅰ期42例,Ⅱ期60例,Ⅲ期28例,分析其临床特点和胸壁复发时间,Kaplan-Meier法计算患者无瘤生存率,采用二元Logistic回归分析复发的影响因素,OR及95％ CI为评价指标,采用Cox回归分析生存期的影响因素,HR及95％CI为评价指标.结果 3、5年无瘤生存率分别为58.4％和33.7％,3、5年总体生存率为91.4％和83.9％,中位发病年龄为45岁,中位复发时间为25个月,中位生存时间为56个月.胸壁复发二元Logistic回归分析显示,肿瘤分期、肿瘤大小及细胞分化程度、雌激素受体(estrogen receptor,ER)、孕激素受体(progesterone receptor,PR)和Ki-67表达、淋巴结转移是影响乳腺癌患者术后胸壁复发的相关因素,均P＜o.05. Cox分析显示,肿瘤分期、肿瘤细胞分化程度、肿瘤病理类型及C-erbB-2表达是影响患者5年总体生存率的因素,均P＜0.05.结论 肿瘤分期晚、肿瘤偏大,肿瘤细胞分化程度低、存在4枚及以上腋窝淋巴结转移、ER和PR低表达及Ki-67高表达是乳腺癌术后胸壁复发的危险因素,而临床分期Ⅲ期、肿瘤细胞低分化、肿瘤病理类型为浸润型癌、C-erbB-2阳性表达是总生存的独立预后因素,对存在上述危险因素的患者,应根据患者情况选择个体化的综合治疗方案,加强随访改善患者预后.     

腋淋巴结阳性乳腺癌结外侵犯的临床意义

目的 探讨乳腺癌患者淋巴结外侵犯(ECE)的临床意义.方法 回顾性分析1230例腋窝淋巴结阳性乳腺癌,观察ECE与临床病理指标之间关系及对患者预后的影响.结果 腋窝淋巴结阳性乳腺癌患者中,ECE阳性率为39.5%.绝经前和绝经后患者ECE的发生率分别为35.5%和47.5%(P＜0.001).ECE阳性组和阴性组的肿瘤直径分别为5.11±2.53 cm和3.90±1.80 cm(P＜0.001),肿瘤直径越大,ECE阳性比例越高(P＜0.001).ECE阳性患者和ECE阴性患者的阳性淋巴结数目分别为16.96±12.16和5.24±6.60(P＜0.001),随腋窝阳性淋巴结数目增多,ECE阳性率明显增加(P＜0.001).ECE的发生与ER、PR状态无显著相关(P=0.706).ECE足乳腺癌患者局部或区域复发的危险因素(P＜0.001),复发时间差异无统计学意义(P=0.559).ECE阳性组和ECE阴性组的远处转移时问分别为30.0个月和37.5个月(P=0.006).首发骨、皮肤和远隔淋巴结组及内脏转移组的ECE阳性率分别为60.4%和42.0%(P=0.001).ECE阳性患者的无转移生存时间、无局部或区域复发生存时间及总生存时间均小于ECE阴性患者.预后单因素和多因素分析显示,ECE是影响乳腺癌患者无转移生存时间、无局部或区域复发生存时间及总生存时间的独立危险因素.结论 乳腺癌患者ECE的发生与肿瘤直径和受累淋巴结数日呈正相关;ECE是乳腺癌局部或区域复发和远处转移的危险因素;ECE是影响乳腺癌患者无转移生存时间、无局部或区域复发生存时间及总生存时间的危险因素.     

Time-varying pattern of recurrence risk for Chinese breast cancer patients

Purpose To analyze the rule of recurrence risk for breast cancer patients after surgery in order to get characteristics for Chinese breast cancer. Methods We performed a retrospective study of 2,213 female unilateral breast cancer patients undergoing surgery in Cancer hospital of Fudan University, Shanghai, China. Survival curves were performed with Kaplan–Meier method and annual recurrence hazard was estimated by hazard function. Results Annual recurrence hazard curve for entire population showed a double-peaked pattern, with a first major recurrence surge reaching the maximum at the second year after surgery and a second recurrence peak near the 9.5th year. The analysis according to tumor size, axillary lymph node (ALN) status (T1 + T2 versus T3, node-positive versus node-negative) and menopausal status as well as hormone receptor (HR) status proved that the double-peaked pattern was present in each subgroup. Compared with ER-positive tumors, ER-negative breast cancers were more likely to recur early. As far as Her-2/neu status was concerned, Her-2/neu-positive patients exhibited a relatively pronounced and variable pattern and tended to have more relapse across all time periods (P < 0.05). Conclusions The double-peaked pattern observed in our patients gives further support to tumor dormancy hypothesis. It contributes to different treatment strategies (e.g. the type and timing of adjuvant therapy) for different patients, which provide the possibility to improve survival. Wenjin Yin and Genhong Di contributed equally to the work.     

Double-peaked time distribution of mortality for breast cancer patients undergoing mastectomy

Purpose. To gather information on the natural history of breast cancer from the time-distribution of deaths of patients undergoing mastectomy alone. Patients and methods. A total of 1173 patients, who entered controlled clinical trials carried out at the Milan Cancer Institute and underwent radical or modified radical mastectomy without any adjuvant therapy for operable breast cancer, were examined. The risk of death at a given time after surgery was studied utilizing the death-specific hazard rate. The risk distribution was assessed relative to tumor size, axillary lymph node involvement, and menopausal status. Results. The hazard rate for death presented an early peak at about the 3rd–4th year after surgery and a second late peak near the 8th year. The double-peaked pattern was almost completely generated by N+ patients, while N– patients did not show relevant structures. Pre-menopausal patients showed an initial mortality wave covering about 6 years, with maximum height at the 4th year, followed by a peak 8 years after surgery, while post-menopausal patients showed an early high mortality surge peaking at the 3rd year, followed by a modest increase at the 8th year. Detailed analysis revealed that post-menopausal patients with early mortality had significantly larger tumors and higher nodal involvement, while no special trait characterized the corresponding pre-menopausal patients. Moreover, patients of the late mortality peak were more likely to have suffered early local-regional or contra-lateral recurrence or to be pre-menopausal patients recurring anywhere at the second recurrence peak. Conclusion. The double-peaked hazard curve confirmed the occurrence of discontinuous features in the natural history of breast cancer for patients undergoing mastectomy. Indeed, the mortality pattern maintained definite signs of the previous double-peaked structure of recurrences. However, death events did not parallel the corresponding recurrence events and, moreover, pre and post-menopausal patients revealed dissimilar survival after recurrence, at least for early deaths. These findings, showing disconnection of mortality pattern from recurrence pattern for subsets of patients, suggest that parameters other than those influencing the recurrence risk may determine the survival of recurred patients.     

Prognosis of operable breast cancers in women aged under forty years]

The present study is based on the data of a homogeneous series of 736 women with stage I and II operable breast cancer. The same methodology was used for treatment and follow-up. Eighty-seven patients were under 40 and 649 between 40 and 70 years ols. No statistical difference was noted between the distribution in these 2 groups regarding tumor size, the axillary or internal mammary nodal status or hormonal receptor levels. Small tumors were noted more frequently in the under 40 yr group. Overall survival was the same in both groups, independently of tumor size, axillary nodal status or hormonal receptors. Disease-free survival differed between the 2 groups: local relapse risk was 1.6 times higher for women under 40 yr, in relation to a higher frequency of conservative treatment in this group. No difference was noted for DFS in relation a tumor size, axillary nodal status of hormonal receptors.     

Prognostic significance of estrogen receptor status in breast cancer in relation to tumor stage, axillary node metastasis, and histopathologic grading

The value of estrogen receptor (ER) measurements for predicting recurrence and survival rates in primary breast cancer was examined in 121 women who were followed from 5 to 12 years after mastectomy with a median follow-up of 64 months. The prognostic significance of the ER status was evaluated independently and in association with tumor stage, axillary node metastasis, and histopathologic grade. The independent evaluation demonstrated no statistically significant difference in prognosis between women with ER-negative and ER-positive cancers, although the latter group tended to have a longer time to recurrence and longer survival. Multivariate analysis of the data by Cox's proportional hazard regression techniques revealed a synergistic effect of ER status on the risk associated with axillary node metastasis. Patients with nodal metastasis were at 2.8 times the risk of recurrence compared to patients without metastasis. For women with nodal metastasis whose primary cancer was ER-negative, this risk increased to 4.6 times compared to women without metastasis and ER-positive tumors (P = 0.0003). The risk of cancer-related death was 5.6 times more likely for poorly differentiated tumors than for highly differentiated tumors. Patients with poorly differentiated ER-negative tumors were at an even higher risk (7.0) of dying than women with highly differentiated ER-positive carcinomas (P = 0.009). In conjunction with tumor stage, axillary node metastasis and histopathologic grade ER determination is useful for identifying subpopulations at increased risk of tumor recurrence or mortality.     

Local recurrences in patients with breast cancer at the North Carolina Memorial Hospital (1970-1982)

A study of predictive factors for locoregional recurrences after curative surgery for breast cancer was undertaken. Specifically, the authors wished to determine whether such recurrences correlated with either hormonal receptor status or a delay between the initial biopsy and the definitive surgery. A retrospective chart review was done on all women with breast cancer who had surgery for cure between 1970 and 1982. Factors analyzed included, among others, size of the tumor, clinical and pathologic status of the axilla, estrogen and progesterone receptors status, and delay between biopsy and definitive surgery. There were 404 patients studied. Pathologic axillary nodal status was the most important predictor of locoregional recurrence, with failures in 36 of 188 (19%) node-positive but only 9 of 216 (4%) node-negative patients (P = 0.0001). In node-positive patients, tumor size was a predictor of local recurrence, with failure in only 4 of 51 (8%) of tumors less than 2 cm, but in 14 of 44 (32%) of tumors greater than 6 cm (P = 0.004). Progesterone receptor (PR) status correlated with locoregional recurrence, but estrogen receptor status did not. In node-positive women, there were 4 of 14 PR-negative but 0 of 15 PR-positive local failures (P = 0.017); this result has not been previously reported. The presence of palpable axillary disease was also found to be a predictor of local recurrence. Finally, no increase in locoregional recurrence could be attributed to the delay between biopsy and definitive surgery. Two new predictors for locoregional recurrence in breast cancer, not previously emphasized, are PR and clinical axillary status. Should these findings be substantiated, patients at high risk for locoregional recurrence could then be more readily identified.     

Time distribution of the recurrence risk for breast cancer patients undergoing mastectomy: Further support about the concept of tumor dormancy

Purpose To gather information on metastatic growth from the time-distribution of first treatment failure in breast cancer patients undergoing mastectomy alone.Methods: The risk of recurrence at a given time after surgery was studied utilizing the cause-specific hazard function. Recurrence was categorized as first treatment failure at any site, local-regional recurrence, distant metastases, and contralateral tumor. The risk distribution was assessed relative to tumor size, axillary lymph node involvement, and menopausal status.Results: A total of 1173 patients treated between 1964 and 1980 with mastectomy alone and no adjuvant therapy were studied. The hazard function for first failure presented an early peak at about 18 months after surgery, a second peak at about 60 months and then a tapered plateau-like tail extending up to 15 years. A similar risk pattern was detectable for both local recurrence and distant metastases, while the curve of contralateral breast tumors showed a near flat plateau. The risk of early local-regional and distant recurrences was much lower for tumors less than 2 cm in diameter than for larger tumors; the risk of late recurrence was similar for small and large primaries. Node-positive patients showed peaks four to five times higher than node-negative patients. Subdividing node-positive patients into 1–3 and > 3 node-positive subsets did not substantially change the general picture of tumor recurrence. The hazard functions for premenopausal and postmenopausal patients were virtually superimposable.Conclusions: The multipeak hazard curve suggests that the process resulting in overt clinical metastases may have discrete features. Primary tumor size could affect in different ways early and late metastases, while axillary node status should be related to the risk level, not to the risk pattern, and menopausal status does not seem to significantly affect the hazard distribution. Moreover, contralateral breast tumors, occurring at constant risk throughout the time, should be considered as second primary cancers. These findings could be reasonably explained by a tumor dormancy hypothesis, which assumes that micrometastases may be in different biological steady states, most of which do not imply tumor growth. Tumor or microenvironment changes could induce metastatic growth after given mean transition times from surgery and originate a discrete pattern of the hazard function.     

Urokinase-plasminogen activator, a new and independent prognostic marker in breast cancer

Urokinase plasminogen activator (UK-PA) is a serine protease implicated in cancer invasion and metastasis. In this investigation, patients with breast cancers containing high levels of UK-PA antigen had significantly higher risk of early disease recurrence and shorter overall survival than did patients with low levels of the protein. In univariate analysis, UK-PA was a more powerful discriminator for disease-free interval than axillary node status, tumor size, or estradiol receptor. For overall survival, UK-PA as a prognostic marker, was of similar magnitude to axillary node status but stronger than that of tumor size or estradiol receptor. In multivariate analysis, for both disease-free interval and survival, UK-PA was an independent risk factor, being independent of tumor size, axillary node status, and estradiol receptor. UK-PA appears to be a new and independent prognostic marker in breast cancer.     

S-phase fraction combined with other patient and tumor characteristics for the prognosis of node-negative, estrogen- receptor-positive breast cancer

Women with estrogen-receptor (ER)-positive breast cancer and no axillary lymph-node involvement are considered to have excellent overall prognosis. However, this population is not homogeneous with regard to risk of recurrence; in fact, some of these patients have a prognosis no better than that of many women with ER-negative tumors or positive axillary nodes. Consequently, better tumor markers and better use of those currently available are needed to distinguish patients who would benefit from more aggressive therapy from those for whom such therapy is unnecessary.A well-defined cohort of over 4000 breast cancer patients from National Surgical Adjuvant Breast and Bowel Project (NSABP) Protocol B-14 who had ER-positive tumors and no axillary lymph-node involvement was analyzed to ascertain the usefulness of tumor cell S- phase fraction for prognosis. The significance of clinical tumor size, patient age at surgery, ER and progesterone receptor (PgR) expression, and nuclear grade was also explored. Statistical methods based on smoothing splines were used to relate treatment failure and mortality rates to patient and tumor characteristics. Models for 5- and 10-year disease-free survival (DFS) and overall survival were developed and summarized. The attenuation of the prognostic importance of covariates over time was investigated.After other characteristics were accounted for, a strong association was found between S-phase fraction and DFS, as well as survival. Tumor size, patient age at surgery, and PgR status were also significantly associated with outcome. The diversity of risk in the B-14 population was more extreme than is generally recognized. The prognostic capabilities of S-phase, tumor size, and PgR status were sharply attenuated as the time from surgery increased.     

Independent prognostic value of laminin receptor expression in breast cancer survival

We studied the possible prognostic role of laminin, estrogen (ER), and progesterone (PR) receptors and other pathological factors in relation to the disease-free interval and overall survival of female breast carcinoma patients. Multivariate analyses of clinical and pathological data with respect to the above survival time variables were performed by Cox regression. The statistical dependence of prognosis on ER, PR, and tumor size was based on the discriminant cutoff value that could best distinguish between survival curves. Axillary nodal status was the most significant independent factor in the prediction of both disease-free interval and overall survival of these patients. Use of the information on laminin receptor expression, PR concentration, tumor size, lymphocytic infiltrate, and tumor necrosis improved significantly the prediction of the risk of recurrence. Patients with tumors expressing laminin receptors had 40% less risk of recurrence (P = 0.0209) than those with no expression. On the other hand, four covariates were independently predictive of the risk of death: axillary nodal status, lymphocytic infiltrate, PR and ER concentration. There was a marginally significant (10% level) interaction between tumor size and lymphocytic infiltrate with respect to the prediction of the risk of recurrence. The above sets of variables were used to classify patients into risk groups for the prediction of recurrence and death.     

Prognostic value of nuclear DNA content in breast cancer in relation to tumor size,nodal status,and estrogen receptor content

Summary The prognostic value of nuclear DNA distribution pattern in relation to tumor size, axillary lymph node status, and estrogen receptor (ER) content was studied in 464 patients with primary, operable mammary adenocarcinoma. The median follow-up time was 3 1/2 years. Slide cytophotometric DNA analysis was performed on morphologically identified Feulgen-stained tumor cells. The tumors were classified into four subgroups according to their DNA histogram type. DNA content was significantly related to tumor size and ER level but not to nodal status. When all variables were stimultaneously introduced into Cox's proportional hazards model, tumor size, nodal status, and DNA profile remained as significant predictors of recurrence. Restricting the analysis to node-negative patients, both DNA profile and tumor size showed a significant prognostic value. DNA did not contribute significant prognostic information in node-positive patients. However, the trends in recurrence-free survival were similar to those in the node-negative subgroup: patients with aneuploid tumors tended to fare worse than those with euploid carcinomas.Presented at the 3rd International Conference on Adjuvant Therapy of Breast Cancer, St. Gallen, Switzerland, March 3–5, 1988