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Prognostic factors affecting the natural history of node-negative breast cancer

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Abstract

Purpose. We undertook a natural history investigation of a broad selection of prognostic factors in a cohort of women with node-negative breast cancer.

Patients and methods. The cohort consisted of 415 consecutive histologic node-negative (T1-3, M0) patients, operated on for primary breast cancer at Women’s College Hospital, Toronto, Canada, between 1977 and 1986. Only 7% of these patients were given adjuvant systemic therapy; further, for the 48% of women who underwent lumpectomy, only 29% received adjuvant radiotherapy to the breast. Paraffin-embedded tumour tissue was available for the majority of patients. The following factors were examined for their univariate and multivariate effects on time to recurrence outside the breast (DFI) and survival from breast cancer (DSS): age, weight, tumour size, estrogen receptor, progesterone receptor, histologic type, tumour grade, nuclear grade, lymphovascular invasion, overexpression of neu oncoprotein, DNA ploidy, % cells in S-phase, and adjuvant therapy. Multivariate analyses utilized a Cox model with a step-wise factor selection for the 260 patients with complete information.

Results. A worse prognosis was indicated when there was lymphovascular invasion (for DFI, p<0.001; for DSS, p=0.0046), high %S-phase (for DFI, p=0.08; for DSS, p=0.02), high tumour grade (for DFI, p=0.02; for DSS, p=0.03), and overexpression of neu oncoprotein (for DSS, p=0.07).

Conclusions. In our natural history investigation, two factors, lymphovascular invasion and tumour grade, are of particular interest since they may be readily incorporated into clinical practice. Overexpression of neu oncoprotein may also play a role in determining prognosis for women administered adjuvant systemic therapy.

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Authors and Affiliations

  1. Department of Medical Oncology, Toronto Sunnybrook Regional Cancer Centre, 2075 Bayview Avenue, T-Wing, T2-023, Toronto, Ontario, Canada, M4N 3M5

    Maureen E. Trudeau, Kathleen I. Pritchard & Carol A. Sawka

  2. Department of Public Health Sciences, University of Toronto, Toronto, Ontario

    Judy-Anne W. Chapman

  3. Department of Pathobiology, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario

    Wedad M. Hanna, Harriette J. Kahn & David Murray

  4. Department of Surgery, Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario

    Betty G. Mobbs, David R. McCready & H. Lavina Lickley

  5. Department of Medical Genetics and Microbiology, Faculty of Medicine, University of Toronto, Toronto, Ontario

    Irene Andrulis

  6. Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario

    Maureen E. Trudeau, Kathleen I. Pritchard & Carol A. Sawka

  7. Henrietta Banting Breast Centre, Sunnybrook & Women’s College Health Sciences Centre, Toronto, Ontario

    Judy-Anne W. Chapman & H. Lavina Lickley

  8. Department of Anatomic Pathology, Sunnybrook & Women’s College Health Sciences Centre, Toronto, Ontario

    Wedad M. Hanna & Harriette J. Kahn

  9. Department of Laboratory Medicine and Pathobiology, St. Michael’s Hospital, Toronto, Ontario

    David Murray

  10. Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario

    Irene Andrulis

  11. Surgical Oncology, University Health Network, Princess Margaret Campus, Toronto, Ontario, Canada

    David R. McCready

Authors
  1. Maureen E. Trudeau
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  2. Kathleen I. Pritchard
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  3. Judy-Anne W. Chapman
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  6. David Murray
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  7. Carol A. Sawka
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  8. Betty G. Mobbs
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  9. Irene Andrulis
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  11. H. Lavina Lickley
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Correspondence to Maureen E. Trudeau.

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Trudeau, M.E., Pritchard, K.I., Chapman, JA.W. et al. Prognostic factors affecting the natural history of node-negative breast cancer. Breast Cancer Res Treat 89, 35–45 (2005). https://doi.org/10.1007/s10549-004-1368-y

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