Prognostic and Predictive Factors in Early-Stage Breast Cancer

Abstract

Breast cancer is the most common malignancy among American women. Due to increased screening, the majority of patients present with early-stage breast cancer. The Oxford Overview Analysis demonstrates that adjuvant hormonal therapy and polychemotherapy reduce the risk of recurrence and death from breast cancer. Adjuvant systemic therapy, however, has associated risks and it would be useful to be able to optimally select patients most likely to benefit. The purpose of adjuvant systemic therapy is to eradicate distant micrometastatic deposits. It is essential therefore to be able to estimate an individual patient's risk of harboring clinically silent micrometastatic disease using established prognostic factors. It is also beneficial to be able to select the optimal adjuvant therapy for an individual patient based on established predictive factors. It is standard practice to administer systemic therapy to all patients with lymph node-positive disease. However, there are clearly differences among node-positive women that may warrant a more aggressive therapeutic approach. Furthermore, there are many node-negative women who would also benefit from adjuvant systemic therapy. Prognostic factors therefore must be differentiated from predictive factors. A prognostic factor is any measurement available at the time of surgery that correlates with disease-free or overall survival in the absence of systemic adjuvant therapy and, as a result, is able to correlate with the natural history of the disease. In contrast, a predictive factor is any measurement associated with response to a given therapy. Some factors, such as hormone receptors and HER2/neu overexpression, are both prognostic and predictive. The Oncologist 2004;9:606-616

Markers of progression in early-stage invasive breast cancer: a predictive immunohistochemical panel algorithm for distant recurrence risk stratification

“…Moreover, the model was significantly associated with both BCSS and metastasis free interval, independently of other factors. This algorithm reiterates the documented prognostic values of these three markers and underscoring the central biologic role played by each of these three markers in breast cancer progression [31][32][33]. According to these results, this small or pruned panel of biomarkers could be used with acceptable success in distant recurrence prediction.…”

Impact of Age, Tumor Size, Lymph Node Metastasis, Stage, Receptor Status and Menopausal Status on Overall Survival of Breast Cancer Patients in Pakistan

“…Thus lymphnode involvement not only predicts survival but also warrants systemic treatment. In a study conducted the 5-year survival for patients with node-negative disease was 82.8% compared with 73% for 1-3 positive nodes, 45.7% for 4-12 positive nodes, and 28.4% for >13 positive nodes (Cianfrocca and Goldstein, 2004). We also observed in our study that 16.5% patients with less than 5 nodes involved survived for more than 10 years but only 5% patients with more than 9 nodes involved survived for more than 10 years suggesting decrease in survival with increase in number of nodes involved.…”

US-guided Core Needle Biopsy of Axillary Lymph Nodes in Patients with Breast Cancer: Why and How to Do It

“…Until some future time when it is replaced with noninvasive imaging techniques, tissue diagnosis of axillary lymph nodes will remain one of the most important prognostic factors in the treatment evaluation of patients with newly diagnosed breast cancer (1)(2)(3). The standard of reference for axillary lymph node staging is dissection (4,5).…”