Clinical features and prognostic factors of early breast cancer at a major cancer center in North India.

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.

Autologous peripheral blood stem cell transplantation: predictors for haematopoietic reconstitution.

Autologous peripheral blood stem cell transplantation is currently used in the treatment of various haematological and non-haematological cancers. Until recently, colony forming unit-granulocyte-macrophage (CFU-GM) assay and mononuclear cell (MNC) count were the indices commonly used to determine the quality of stem cell grafts and the haematopoietic reconstitutive capacity of transplanted stem cells. However, the discovery of CD34 as a stem cell marker has revolutionized the assessment of progenitor cells present in the peripheral blood stem cell graft. Many studies have included enumeration of CD34+ cells, MNCs and CFU-GM assay in stem cell grafts, and their correlation with engraftment has also been studied. However, there is no consensus regarding the optimum dose of each parameter that ensures haematopoietic recovery in all patients. We discuss the stem cell biology and review the literature on stem cell characteristics influencing successful haemopoietic reconstitution.