ABSTRACT
BACKGROUND: Data on the clinical profile of early breast cancer (EBC) from India is scant. Due to differences in genetics, environment, lifestyle, socio-demographic structure and ethnicity, the presentation and behavior of breast cancer in India may be different. AIMS: To analyze the clinical presentation and outcome of EBC patients. SETTINGS AND DESIGN: A single center retrospective study. MATERIALS AND METHODS: Data from 487 EBC patients registered and treated at our institute from 1993 through 1999 were analyzed. Cox's multivariate regression test was used to determine prognostic factors for overall and disease-free survival (OS & DFS). RESULTS: The median age was 47 years and 49.7% patients were pre-menopausal. Ninety-six per cent patients presented with a lump. Stages I, IIa, and IIb comprised 7.8%, 38.8%, and 47.6% respectively. Only 11.3% patients opted for breast-conserving surgery (BCS) while the remaining 88.7% underwent modified radical mastectomy (MRM). Adjuvant chemotherapy was administered to 275 (56.5%), and radiotherapy to 146 (29.9%). Estrogen receptor status was known in 173, of whom 93 (53.7%) were positive. Most patients were prescribed Tamoxifen for 5 years. At a median follow-up of 48 months, 126 (25.9%) patients had relapsed (systemic 107, loco-regional 19) and 94 (19.3%) had died. Five-year DFS and OS were 73% and 78%, respectively. On multivariate analysis, four positive nodes adversely influenced survival (P< 0.01). CONCLUSIONS: The median age at presentation was 47 years, significantly lower than most Western figures. The majority (86.4%) had a lump size > two cm. BCS was done in only 11% and the rest underwent MRM. Nodal involvement was the significant prognostic factor.
Subject(s)
Adult , Aged , Aged, 80 and over , Breast Neoplasms/diagnosis , Combined Modality Therapy , Disease-Free Survival , Female , Humans , India/epidemiology , Medical Records , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Staging , Neoplasms, Hormone-Dependent/diagnosis , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk Factors , Survival AnalysisABSTRACT
La cuantificación de los receptores hormonales empleando hormona radiactiva en neoplasias hormonodependientes regularmente se realiza únicamente en el citosol celular. Esta determinacon es incompleta, ya que la presencia de los receptores localizados en el núcleo no se efectúa y, por lo tanto, no se determina la totalidad de los receptores en un tumor. En el presente estudio se otimizó la cuantificación de los receptores hormonales para estradiol localizados en el núcleo celular, empleando diferentes temperaturas de incubación con la hormona radiactiva (4,22 y 37 Grados C). Los receptores nucleares se extrajeron de la cromatina con soluciones amortiguadoras de KC1 0.4 M. se emplearon como modelo experimental úteros de ratas Wistar, adrenalectomizadas y ooforectomizadas, las cuales fueron posteriormente estimuladas con estradiol, progesterona y vehículo de administración. Se pudo observar que la cuantificación de los receptores nucleares para estradiol a 22 Grados C detecta un 13 por ciento más de estas proteínas, sin que se vea afectada por la temperatura la afinidad del receptor por su hormona. El receptor de progesterona no se pudo detectar en el núcleo, ya que al parecer es altamente sensible al KC1. En conclusión, es factible determinar los receptores nucleares para estradiol, empleando incubaciones a 22 Grados C como temperatura óptima en el núcleo.