Tumour size and vascular invasion predict distant metastasis in stage I breast cancer. Grade distinguishes early and late metastasis

Abstract

Background: Recent Dutch guidelines recommend adjuvant systemic treatment (AST) for women with high grade stage I breast carcinoma >1 cm. High grade is defined as Bloom and Richardson grade 3 (B&R3), Nottingham modification, or mitotic activity (MAI) >10/1.59 mm 2 . Aims: To investigate the validity of these histological prognostic factors as the exclusive defining criteria. Materials/methods: Fifty patients with stage I breast carcinoma who developed distant metastases and 50 matched controls without metastasis were studied; none had received AST. Results: Cases more often had tumours >1 cm (p = 0,019), B&R3 tumours (p = 0.059), grade 3 nuclei (p = 0.005), and vascular invasion (p = 0.007). No differences were found for MAI >10 (p = 0.46). In multivariate analysis, the only significant variables were vascular invasion and tumour size (odds ratios: 8.21 and 5.35, respectively). In a separate analysis, the 50 cases were divided into 25 patients with early and 25 with late metastasis. Those with early metastasis more often had B&R3 tumours (p = 0.009) and grade 3 nuclei (p = 0.006). No differences were found for tumours >1 cm, vessel invasion, or MAI >10. Using the present Dutch guidelines for AST, based on B&R3, 20 cases and 11 controls would have received AST. Based on MAI >10, 14 cases and 11 controls would have received AST. Conclusions: Tumour size and vessel invasion are the best prognostic factors for disease free survival in patients with stage I breast cancer. Dutch selection criteria for AST for these patients need to be improved. Some prognostic factors are time dependent, making their use as selection criteria for AST more complicated.

Predictive Role of Tumor Size in Breast Cancer with Axillary Lymph Node Involvement - Can Size of Primary Tumor be used to Omit an Unnecessary Axillary Lymph Node Dissection?

“…We also observed a decreasing trend in tumor size, which may be associated with increasing awareness about breast cancer and to a certain extent, with the introduction of the mammographic breast screening program in Iran since 1993. This result was comparable with other studies (Westenend et al, 2005;Pathy et al, 2011). The most common site for breast cancer was the upper outer quadrant that constituted 53.9% of the studied cases.…”

“…Prognostic factors that are considered valuable in predicting axillary nodal status for patients with invasive breast cancer include: age, vascular invasion, hormonal receptors, menopausal status, histological grade, nuclear grade, lympho-vascular invasion, DNA ploidy and palpability of the primary tumor. But only the size of primary tumor, as an independent factor, seems to have a statistically significant relationship with lymph node metastases (Ahlgren et al, 1994;Port et al, 1998;Gajdos et al, 1999;Mann et al, 1999;Bourez et al, 2002;Westenend et al, 2005).…”

“…The presence or absence of axillary lymph node involvement (ALNI) is the most important prognostic indicator for patients with early stage breast cancer (Rosen et al, 1993;Cianfrocca and Goldstein, 2004;Westenend et al, 2005;Lee et al, 2010). Increasing the number of involved axillary lymph nodes (ALN) is associated with an increased probability of recurrence and mortality (Colleoni et al, 2005).Efforts have been made to identify factors which can predict the risk of axillary lymph node involvement.…”

Phosphohistone H3 expression has much stronger prognostic value than classical prognosticators in invasive lymph node-negative breast cancer patients less than 55 years of age

“…In addition, not all studies confirm the prognostic value of proliferation factors. 24,25 This may be due to differences in sample processing, methodological differences in MAI assessment, or inclusion of patients over 70 years of age (MAI is not prognostic in these patients 17 ). Tissue processing is an unlikely source of disparity in most pathology laboratories, as mitoses are stable and robust with application of certain simple and widely used precautions.…”

The Comparison of Stereological Calculations of Tumour Volume with Prognostic Parameters in Breast Cancer

“…In another study, Westenend et al grouped 100 cases as those with and without distant metastasis such that each of the two groups comprised of 50 patients, and found out that vascular invasion and tumour diameter were both closely related to metastatic potential and prognosis (15).…”