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Confirmation of a prognostic index for patients with metastatic breast cancer treated by endocrine therapy

Breast Cancer Research and Treatment volume 22, pages 221–227 (1992)Cite this article

Summary

We have previously reported a retrospectively constructed index which can accurately predict survival at the time of diagnosis of symptomatic metastatic breast cancer. The index, derived from a Cox model, is scored: Index score = (4 × Grade) − (6 × ER) + (4 × SIMD) − (0.1 × DFI), where histological grade is scored 1–3 (good, moderate, or poor), oestrogen receptor (ER) is scored 0 (negative) or 1 (positive), site of initial metastasis (SIMD) is scored 1–4 for bone only, lung only, bone and lung, or visceral metastases, respectively, and disease-free interval (DFI) is measured in months. Patients were divided into three prognostic groups on the basis of index score.

In the present study we have tested this index prospectively on a new group of 147 patients with metastatic breast cancer. The percentage of patients in each of the three groups was similar between the retrospective and prospective studies. In the prospective study the difference in survival between the 3 groups was highly significant (p<0.001), confirming our retrospective analysis. No single one of the four factors was as powerful in predicting survival as the index itself. We now use this index in our patient management.

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References

  1. Williams MR, Todd JH, Nicholson RI, Elston CW, Blamey RW, Griffiths K: Survival patterns in hormone treated advanced breast cancer. Br J Surg 73:752–755, 1986

    Google Scholar 

  2. Blanco G, Hollf K, Heikkin M, Kallioniemi O-P, Taskinen P: Prognostic factors in recurrent breast cancer: Relationships to site of recurrence, disease-free interval, female sex steroid receptors, ploidy and histological malignancy grading. Br J Cancer 62:142–146, 1990

    Google Scholar 

  3. Hayward JL, Carbone PP, Heuson JC, Kumaoka S, Segaloff A, Rubens RD: Assessment of response to therapy in advanced breast cancer: A project of the Programme on Clinical Oncology of the International Union Against Cancer, Geneva, Switzerland. Cancer 39:1289–1294, 1977

    Google Scholar 

  4. British Breast Group. Assessment of response to treatment in advanced breast cancer. Lancet ii:38–39, 1974

    Google Scholar 

  5. Elston CW, Ellis IO: Prognostic factors in breast cancer. I. The value of histological grade in breast cancer: Experience from a large study with long term follow-up. Histopath 19:403–410, 1991

    Google Scholar 

  6. Nicholson RI, Campbell FC, Blamey RW, Elston CW, George D, Griffiths K: Steroid receptors in early breast cancer. J Ster Biochem 15:193–199, 1981

    Google Scholar 

  7. Nicholson RI, Colin P, Francis AB, Keshra R, Finlay P, Williams M, Elston CW, Blamey RW, Griffiths K: Evaluation of an enzyme immunoassay for estrogen receptors in human breast cancers. Cancer Res 46:4299s-4302s, 1986

    Google Scholar 

  8. Hahnel R, Woodings R, Vivian AB: Prognostic value of oestrogen receptors in primary breast cancer. Cancer 44:671–675, 1979

    Google Scholar 

  9. Stewart JF, King RJB, Sexton SA, Millis RR, Rubens RD, Hayward JL: Oestrogen receptors, site of metastatic disease, and survival in recurrent breast cancer. Eur J Cancer 17:449–453, 1981

    Google Scholar 

  10. Kinne DW, Ashikari R, Butler A, Menendez-Botet C, Rosen PP, Schwartz M: Estrogen receptor protein in breast cancer as a predictor of recurrence. Cancer 47:2364–2367, 1981

    Google Scholar 

  11. Paterson AHG, Suck VP, Szafran O, Lees AW, Hanson J: Influence and significance of certain prognostic factors on survival in breast cancer. Eur J Cancer Clin Oncol 18:937–943, 1982

    Google Scholar 

  12. Howat JMT, Harris M, Swindell R, Barnes DM: The effect of oestrogen and progesterone receptors on recurrence and survival in patients with carcinoma of the breast. Br J Cancer 51:263–270, 1985

    Google Scholar 

  13. Williams MR, Todd JH, Ellis IO, Dowle CS, Haybittle JL, Elston CW, Nicholson RI, Griffiths K, Blamey RW: Oestrogen receptor in primary and advanced breast cancer: An eight year review of 704 cases. Br J Cancer 5:67–73, 1987

    Google Scholar 

  14. Howell A, Harland RNL, Bramwell VHC, Swindell R, Branes D, Redford J, Wilkinson MJS, Crowther D, Sellwood RA: Steroid hormone receptors and survival after first relapse in breast cancer. Lancet i:588–591, 1984

    Google Scholar 

  15. Baildam AD, Zaloudik J, Howell A, Barnes DM, Turnbull L, Swindell R, Moore M, Sellwood RA: DNA analysis by flow cytometry, response to endocrine therapy, and prognosis in advanced carcinoma of the breast. Br J Cancer 55:553–559, 1987

    Google Scholar 

  16. Lovekin C, Ellis IO, Locker AP, Robertson JFR, Elston CW, Blamey RW: C-erbB-2 oncoprotein expression in primary and advanced breast cancer. Br J Cancer 63:439–443, 1991

    Google Scholar 

  17. Cutler SJ, Ardyce AJ, Taylor SG: Classification of patients with disseminated cancer of the breast. Cancer 24:861–869, 1969

    Google Scholar 

  18. Fey MF, Brunner KW, Sonntag RW: Prognostic factors in metastatic breast cancer. Cancer Clin Trials 4:237–247, 1981

    Google Scholar 

  19. Nikkanen TAV: Recurrence of breast cancer. Acta Chir Scand 147:239–245, 1981

    Google Scholar 

  20. Campbell FC, Blamey RW, Elston CW, Nicholson RI, Griffiths K, Haybittle JL: Oestrogen-receptor status and sites of metastases in breast cancer. Br J Cancer 44:456–459, 1981

    Google Scholar 

  21. Clark GM, Sledge GW Jr, Osborne CK, McGuire WL: Survival from first recurrence: Relative importance of prognostic factors in 1,015 breast cancer patients. J Clin Oncol 5:55–61, 1987

    Google Scholar 

  22. Devitt JE: The enigmatic behavior of breast cancer. Cancer 27:12–17, 1971

    Google Scholar 

  23. Pater J, Mores D, Loeb M: Survival after recurrence of breast cancer. Can Med Assoc J 124:1591–1595, 1981

    Google Scholar 

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Affiliations

  1. Tenovus Institute, Cardiff, U.K.

    RI Nicholson

  2. Professorial Unit of Surgery, City Hospital, NG5 1PB, Nottingham, U.K.

    JFR Robertson, AR Dixon, IO Ellis, CW Elston & RW Blamey

Authors
  1. JFR Robertson
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  2. AR Dixon
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  3. RI Nicholson
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  4. IO Ellis
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  5. CW Elston
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  6. RW Blamey
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Robertson, J., Dixon, A., Nicholson, R. et al. Confirmation of a prognostic index for patients with metastatic breast cancer treated by endocrine therapy. Breast Cancer Res Tr 22, 221–227 (1992). https://doi.org/10.1007/BF01840835

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  • DOI: https://doi.org/10.1007/BF01840835

Key words

  • endocrine therapy
  • histological grade
  • metastatic breast cancer
  • oestrogen receptor
  • prognostic index
  • site of metastasis