THE PROGNOSTIC EFFECT OF HISTOLOGICAL TUMOR GRADE IN NODE-NEGATIVE BREAST-CANCER PATIENTS

被引:45
作者
SCHUMACHER, M
SCHMOOR, C
SAUERBREI, W
SCHAUER, A
UMMENHOFER, L
GATZEMEIER, W
RAUSCHECKER, H
机构
[1] UNIV GOTTINGEN,INST PATHOL,W-3400 GOTTINGEN,GERMANY
[2] UNIV GOTTINGEN,DEPT SURG,W-3400 GOTTINGEN,GERMANY
关键词
BREAST CANCER; COX REGRESSION; HISTOLOGIC TUMOR GRADING; NODE NEGATIVE; PROGNOSIS;
D O I
10.1007/BF00689838
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The prognostic effect of histological tumor grade was evaluated in 1036 patients with early breast cancer (pT1 pN0 M0) entered into a trial comparing mastectomy and breast preserving treatment. All analyses were adjusted for the factors treatment, patients' age, and tumor size. Tumor grade was defined according to Bloom and Richardson based on the sum of scores assigned to each of three histological features: 1) degree of differentiation, 2) pleomorphism, and 3) mitotic index. The relative importance of these factors with regard to disease-free survival was evaluated. In univariate as well as in multivariate analyses the pleomorphism was the only factor showing a significant effect (univariate: p = 0.0024, multivariate: p = 0.015). It was investigated how the factors should be combined to define a histological grading score which yields the best possible classification of the patients with respect to prognosis. A new grading system was defined splitting the patients into three groups: 1) pleomorphism 1; 2) pleomorphism 2 or pleomorphism 3 and mitotic index 1; 3) pleomorphism 3 and mitotic index 2 or 3. This yields a good classification of the patients with respect to prognosis (p = 0.0004). The prognostic effect of this score was compared with the effects of the grading systems proposed in the literature. According to Bloom and Richardson and in the modified version by Schauer and Weiss, grading is based on the sum of scores of the various histological factors. Therefore, the strong effect of the pleomorphism was diluted in these grading definitions (Bloom and Richardson: p = 0.03, Schauer and Weiss: p = 0.028). The grading system proposed by Le Doussal et al. consists only of the scores of pleomorphism and mitotic index (p = 0.014). In summary, the factor pleomorphism showed a stronger effect on disease-free survival by itself than the grading systems proposed in the literature.
引用
收藏
页码:235 / 245
页数:11
相关论文
共 32 条
[1]   HISTOLOGICAL GRADING AND PROGNOSIS IN BREAST CANCER - A STUDY OF 1409 CASES OF WHICH 359 HAVE BEEN FOLLOWED FOR 15 YEARS [J].
BLOOM, HJG ;
RICHARDSON, WW .
BRITISH JOURNAL OF CANCER, 1957, 11 (03) :359-&
[2]  
BOJAR H, 1986, CANCER RES, V44, P4249
[3]  
Breiman L, 2017, CLASSIFICATION REGRE, P368, DOI 10.1201/9781315139470
[4]   TUMOR GRADE AS A PROGNOSTIC FACTOR IN PRIMARY BREAST-CANCER [J].
CONTESSO, G ;
JOTTI, GS ;
BONADONNA, G .
EUROPEAN JOURNAL OF CANCER & CLINICAL ONCOLOGY, 1989, 25 (03) :403-409
[5]  
COX DR, 1972, J R STAT SOC B, V34, P187
[6]  
DAVIS BW, 1986, CANCER-AM CANCER SOC, V58, P2662, DOI 10.1002/1097-0142(19861215)58:12<2662::AID-CNCR2820581219>3.0.CO
[7]  
2-Y
[8]   A RANDOMIZED CLINICAL-TRIAL EVALUATING SEQUENTIAL METHOTREXATE AND FLUOROURACIL IN THE TREATMENT OF PATIENTS WITH NODE-NEGATIVE BREAST-CANCER WHO HAVE ESTROGEN-RECEPTOR-NEGATIVE TUMORS [J].
FISHER, B ;
REDMOND, C ;
DIMITROV, NV ;
BOWMAN, D ;
LEGAULTPOISSON, S ;
WICKERHAM, DL ;
WOLMARK, N ;
FISHER, ER ;
MARGOLESE, R ;
SUTHERLAND, C ;
GLASS, A ;
FOSTER, R ;
CAPLAN, R .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (08) :473-478
[9]   A RANDOMIZED CLINICAL-TRIAL EVALUATING TAMOXIFEN IN THE TREATMENT OF PATIENTS WITH NODE-NEGATIVE BREAST-CANCER WHO HAVE ESTROGEN-RECEPTOR POSITIVE TUMORS [J].
FISHER, B ;
COSTANTINO, J ;
REDMOND, C ;
POISSON, R ;
BOWMAN, D ;
COUTURE, J ;
DIMITROV, NV ;
WOLMARK, N ;
WICKERHAM, DL ;
FISHER, ER ;
MARGOLESE, R ;
ROBIDOUX, A ;
SHIBATA, H ;
TERZ, J ;
PATERSON, AHG ;
FELDMAN, MI ;
FARRAR, W ;
EVANS, J ;
LICKLEY, HL ;
KETNER, M .
NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (08) :479-484
[10]   TUMOR NUCLEAR GRADE, ESTROGEN-RECEPTOR, AND PROGESTERONE-RECEPTOR - THEIR VALUE ALONE OR IN COMBINATION AS INDICATORS OF OUTCOME FOLLOWING ADJUVANT THERAPY FOR BREAST-CANCER [J].
FISHER, B ;
FISHER, ER ;
REDMOND, C ;
BROWN, A .
BREAST CANCER RESEARCH AND TREATMENT, 1986, 7 (03) :147-160