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Original Summaries of Selected CANCERLIT Abstracts.
The Search for Prognostic Factors in Breast Cancer
Last modified on:
Tuesday, April 20, 1999 10:52:30
Copyright © 1994-2008, Information Ventures, Inc.
The search for prognostic factors is constantly widening, but in
many cases the correlations seen are often of more statistical than
clinical significance. Nevertheless, it is necessary to establish
which tests are of clinical value by examining a whole battery of
prognostic tests. In one example, characteristics of patient and
tumor were studied at the Uppsala University in Sweden (Norden;
ICDB/95615293). There were two population-based cohorts of women
treated for primary breast cancer from 1977 through 1988, and also
from 1989 through 1992, when the impact of introduction of
mammography screening on tumor characteristics could be studied.
Age at diagnosis was related to the presence of axillary lymph node
metastases (p = 0.04) in a study of 725 women. Women aged 50-59
were at an increased risk compared to those younger and older, in
contrast to the findings from registry studies, where perimenstrual
women have the best prognosis. Thus, the route of spread might be
age-dependent. Estrogen receptor (ER) status did not relate to
corrected survival, whereas progesterone receptor (PR) level,
histopathological classification, and DNA ploidy did. ER levels
may have a prognostic implication primarily by predicting response
to hormonal treatment. A prognostic index suggested by others
based on tumor diameter greater than or equal to 20 mm, ER negative
or PR negative status, and aneuploidy was tested. Women without
node involvement and with three or four of these signs had a 5-year
corrected survival rate of 68%, similar to those doing best among
node-positive women. Plasma estradiol levels the day before
surgery were not related to corrected survival in 86 premenopausal
and 350 postmenopausal women, suggesting that the relationship
which has been observed between timing of surgery within the
menstrual cycle and survival does not depend on circulating
estradiol levels. The expression of HLA-DR antigen was not
statistically significantly associated with corrected survival or
preoperative serum estradiol levels, but a relation to preoperative
follicle stimulating hormone (FSH) levels and to estrogen receptor
status was found in 240 women. The only characteristic of tumors
detected by mammography screening was a markedly reduced risk for
node involvement at operation (odds ratio of 0.36), even after
correcting for tumor size, in all age groups.
In contrast to this finding of multiple significant indicators, is
the summation of data from the Breast Cancer Working Committee of
the Autologous Blood and Marrow Transplant Registry-North America
(Rowlings; ICDB/95614118). Among 930 women with metastatic disease
receiving autotransplants (bone marrow) at 52 institutions in North
America between 1989 and 1993, the only major predictor of
progression-free survival was a complete response to chemotherapy
prior to autotransplant.
November, 1995
Copyright (c) 1994-2008, Information Ventures, Inc.
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