THE PROGNOSIS OF BREAST-CANCER PATIENTS IN RELATION TO THE ESTROGEN-RECEPTOR STATUS OF BOTH PRIMARY DISEASE AND INVOLVED NODES

Nodal involvement is accepted as the best single marker of prognosis in breast cancer. However. there is little information on the sub-division of node-positive patients according to the oestrogen receptor status of the nodal tissue. We have previously reported (Eur. J. Ca. 1987, 23, 31) that, in almost all cases, involved nodes are only oestrogen receptor positive (ER+) in patients whose primary tumours are uniformly ER+. This paper presents clinical follow-up on a larger group of patients with node positive breast cancer. For each patient, both soluble and nuclear receptor concentrations were determined in three separate parts of the primary tumour and in at least one involved node (we have previously defined tumours which contained ER in all six fractions of the primary as HS+ +, those lacking receptor in some fractions as HS+ - and wholly receptor negative tumours as HS- -). Median follow-up time was 71.5 months. As expected, patients whose tumours were HS+ + had a significant (P < 0.008) survival advantage. More importantly, patients with ER in both the soluble and nuclear fractions of their involved nodes survived significantly (P < 0.003) longer than those with ER- nodes. Thus, full oestrogen receptor status of involved nodes will give sufficient prognostic information when adequate primary tissue is not available.