Abstract
Increasing interest has been focused on DNA ploidy, hormone receptor status and tumour size as prognostic factors in node-negative breast cancer. We analysed these factors in patients operated on for primary invasive breast cancer between January 1981 and December 1987 in a prospective study of 248 women with no involved axillary nodes and 188 women with positive nodes followed until 15 April 1989. Oestrogen or progesterone receptor negativity, aneuploidy and tumour diameter exceeding 20 mm were studied as negative prognostic signs in life table analyses and Cox proportional hazards models of corrected survival. Corrected survival decreased with increasing number of negative signs. Three to four signs yielded a statistically significant, two- to threefold higher risk than the others. Survival estimates by life table analyses differed by 20% at 5 years. In the whole group, women with three or four negative factors had a relative risk of dying from their disease more than twice that of the others. Women with no involved nodes and with three or four negative factors had a risk of dying from breast cancer similar to that of node-positive women with fewer than three.
Highlights
Adjuvant systemic therapy after primary surgery for breast cancer is of benefit to node-negative as well as node-positive patients (Early Breast Cancer Triallists' Collaborative Group, 1992)
A total of 525 women were surgically treated for a primary invasive breast cancer between January 1981 and December 1987
The effect of the hazard associated with the variable xl is exp (PI), which we call the relative hazard (RH)
Summary
Adjuvant systemic therapy after primary surgery for breast cancer is of benefit to node-negative as well as node-positive patients (Early Breast Cancer Triallists' Collaborative Group, 1992). The proportional reduction in recurrence and death with adjuvant treatment may be of an equal magnitude in both groups. A recommendation in a Clinical Alert from the National Cancer Institute (1988) to give adjuvant therapy to all node-negative patients has met with opposition because of the limited absolute gain and relatively common side-effects (DeVita, 1989; McGuire et al, 1989, 1990). There is growing interest in finding prognostic factors that can select women at high risk for distant metastases and death from node-negative breast cancer (McGuire et al, 1990)
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