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Predicting recurrence in axillary-node negative breast cancer patients



Predicting recurrence in axillary-node negative breast cancer patients



Breast Cancer Research & Treatment 25(2): 127-139



The study attempted to identify the risk groups in axillary node negative breast cancer patients using validated first-generation prognostic clinical and pathologic factors. An updated 10-year follow-up in 407 such patients treated by surgery alone at Roswell Park between 1976-1987 showed a 10-year recurrence rate (RR) of 19% (95% confidence interval +-5%). Predictors of outcome were, in order of strength: Tumor size (p=0.0006); RR at 10 years was 2%+-4 for tumors ltoreq 0.5cm, 6%+-7 for tumors 0.6-1.0cm, 16%+-9 for 1.1-2cm, 29%+-12 for 2.1-5cm; and 40%+-31 over 5cm; Histologic differentiation (p=0.017); poorly differentiated/ anaplastic (P/A) tumors had a greater RR (24%+-8) than well or moderately differentiated (W/M) tumors (13%+-8); Age(p=0.046); patients lt 35 showed a RR of 28%+-20, pts 35-50, 22%+-10, and pts gt 50, 17%+-7 (p=0.046). Cox Model analysis showed tumor size (4 groups) significant at lt 0.0001, histologic differentiation (2 groups) significant at lt 0.0005 after allowing for size, and age (+-50) significant at lt 0.05 after allowing for size and differentiation. Combining these variables into subgroups enables selecting groups at various risks of recurrent. Groups with low risk are: patients with tumor ltoreq 1cm, W/M (0% RR), patients with ductal carcinoma in situ with microinvasion (0% RR), and patients with tumors ltoreq cm, P/A (8% RR). In a suggestive finding in this last group, those over age 50 achieved a RR of 3%+-6, while those age 50 or less had RR 14%+-15. With the exception of this last group, all should be considered highly curable using loco-regional therapy alone, and might be spared the risks and costs of routine systemic adjuvant therapy. Groups with high risk are: patients with tumors gt 2cm (RR 32%+-12), and patients with tumors 1.1-2cm, P/A (RR 21%+-14). These should receive adjuvant therapy. Groups with intermediate risk are patients with tumor 1.1-2cm, W/M (RR 12%+-12). In a suggestive finding, those in this group over age 50 had a RR of 11%+-12, while those up to 50 had a RR of 17%+-30. These patients should be considered to be prime candidates for clinical trials. Adding second generation factors such as DNA ploidy or S-phase fraction of first generation factors should provide additional information on which to base therapy decisions, particularly in the gray area of intermediate risk. Our study indicates that node-negative breast cancer patients represent a heterogeneous population in terms of risk and prognosis, and that an individualized approach to adjuvant therapy should be taken.

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Accession: 009227143

Download citation: RISBibTeXText

PMID: 8347845

DOI: 10.1007/bf00662138



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