Prognostic value of CEA and ferritin assay in breast cancer: a multivariate analysis.

The prognostic significance of preoperative serum carcinoembryonic antigen (CEA) and ferritin levels was evaluated in 191 women operated for breast cancer. The influence of CEA, ferritin and another 11 clinical and pathological features on the disease-free survival was investigated in a multivariate analysis, using Cox's proportional hazard model. Axillary node status (P = 0.004), CEA level (P = 0.011), and the histological grade of the tumor (P = 0.029) emerged as independent prognostic factors. By contrast, no significant relationship was found between ferritin and disease-free survival. These three parameters were used to derive a prognostic index (I) for each patient. Multivariate analysis showed that its prognostic value was better than the value of any single factor (P less than 0.0001). The I score was used to divide patients into groups at different risk of recurrence: low, moderate and high (97.5%, 45% and 22.5% of recurrence-free patients at 3 years respectively). The data showed that the prognosis of patients with different combinations of node status and tumor grade was related to the level of CEA. Only women with very good (node-negative with well-differentiated tumors) or very bad prognosis (node-positive with four or more metastatic nodes and poorly differentiated tumors) had a disease-free survival independent of CEA values. These findings suggest that the preoperative measurement of CEA enhances the possibility of correctly predicting outcome and hence could be of assistance in the planning of adjuvant therapies.

The correlation between the spread of metastases by level in the axillary nodes and disease-free survival in breast cancer. A multifactorial analysis.

Axillary lymph nodes were separated from 492 radical or modified radical mastectomies for primary breast cancer and examined according to their anatomical level corresponding to their position along the theoretical pathway of lymph drainage from the breast. The patterns of metastasis and the relationship between metastatized levels and disease-free survival were investigated to see whether complete axillary dissection is necessary for the staging and the planning of adjuvant therapy in breast cancer. Progressive involvement from level I (proximal) to level III (distal) was found in 206 specimens (80.8% of tumors with axillary metastases), while discontinuous or "skip" metastases were present in 49 (19.2%), including 38 (14.9%) with positive nodes at level II or III but not at level I. "Skip" metastasis was more frequent when fewer than four nodes were positive, and not related to either the size of the primary tumor or its location. The effect of age, menopausal status, tumor size, node status, number of positive nodes, anatomic level of axillary node involvement, estrogen and progesterone receptors, and adjuvant therapies on disease-free survival was evaluated using a multivariate proportional hazard model and life table analysis. This showed that disease-free survival was strongly related to the number of positive nodes (P less than 0.001), tumor size (P = 0.001) and level of node involvement (P = 0.01) as independent prognostic factors. Moreover, the subset of patients with four or more positive nodes and involvements of level III had a higher risk of recurrence (25% recurrence-free patients 5 years after mastectomy). The high frequency of "skip" metastases and the prognostic value of both the level of involvement and the number of metastatic nodes suggest that a complete axillary dissection is needed in the surgical management of breast cancer to obtain all the data useful in the planning of adjuvant therapy.

The influence of hormone receptors and hormonal adjuvant therapy on disease-free survival in breast cancer: a multifactorial analysis.

The prognostic value of estrogen (ER) and progesterone (PgR) receptor status and the influence of hormonal adjuvant therapy on disease-free survival (DFS) in breast cancer were evaluated in 680 women after radical and modified radical mastectomy. The effect of 17 variables, including clinical data, TNM, hormone receptor status, histology and adjuvant therapy, on the DFS observed was analyzed, using a multivariate proportional hazard model. Multifactorial analysis revealed that DFS was strongly related to the number of positive axillary nodes (P less than 0.001) and the histological grade of the tumor (P = 0.05). Moreover, the DFS of ER-positive patients with node involvement was significantly improved by hormonal adjuvant therapy (tamoxifen). Combination of adjuvant chemotherapy with hormonal therapy did not enhance its effectiveness. Recurrence rates of either node-negative or ER-negative patients were not affected by either adjuvant therapy. When no systemic therapy was given, no significant relationship between ER or PgR content of the tumor and the DFS was observed. These findings suggest that hormone receptor status is not an independent prognostic factor but provides reliable information on responsiveness to adjuvant hormonal therapy which is very effective in patients selected on the basis of ER assay.

The correlation between estrogen and progesterone receptors and some clinical and pathological features in human breast cancer.

The correlation between estrogen (ER) and progesterone (PgR) receptor status and some clinical and pathological features was evaluated in a series of 680 breast carcinomas. ER status was significantly related to age, menopause, histological grade and vascular invasion. No relationship was found with tumor size, lymph node involvement, histotype and multicentricity. PgR status was significantly related to vascular invasion only. Despite the relationship between ER and favorable pathological features, ER-positive patients did not show a longer disease-free interval after surgery when no systemic adjuvant therapy was administered. ER status is thus of little prognostic value.

The correlation between estrogen receptor status, axillary-node metastases and disease-free interval after surgery in primary breast cancer.

The prognostic value of estrogen receptor (ER) status in primary breast cancer was evaluated in 208 women subjected to Halsted radical mastectomy. The correlation between ER status, node involvement and disease-free interval after surgery was analyzed in detail. Forty-seven out of 127 ER-positive patients received hormonal adjuvant therapy, whereas the 81 ER-negative patients did not. Similar recurrence rates were found in ER-negative and untreated ER-positive patients, suggesting that the natural course of disease was not related to ER status. ER-positive patients who received hormonal adjuvant therapy showed a significantly longer disease-free interval than both ER-negative and untreated ER-positive patients, even though a higher frequency of node involvement was found in ER-positive tumors. Since only hormone-treated ER-positive patients showed a significantly lower recurrence rate, it is felt that ER status cannot be used as an independent prognostic factor.

[Arterial chemotherapy of tumors. Considerations on 159 cases]. / Chemioterapia arteriosa dei tumori. Considerazioni su una casistica di 159 casi.

The results obtained in 153 patients suffering from advanced primary, residual, recurrent and metastatic cancers localized mainly in the cervico-cephalic district and in other sites (skin, extremities and pelvis, liver, thoracic wall, breast) in whom locoregional intraarterial chemotherapy was employed from 1967, are reported. In order of frequency, the commonest antiblastics used were Methotrexate, 5 FU, Vincristin and DITC. Long-term results show an average remission of 52% and mean survival of 11.4 months; these values are liable to wild fluctuations in relation to various factors such as site, development, state of regional lymph nodes, and any previous surgical, radiation or antiblastic therapy. Intraarterial treatment is found to have the best effect in cases of cancer which have not previously been subjected to any therapy at all, and which involve the cervico-cephalic districts, the liver and melanomas.

[Palliative demolitive surgery]. / Chirurgia demolitiva a scopo palliativo

Nine cases of untreatable tumour in which radical surgery was employed palliatively are presented. Three hemipelvectomies for recurrent rhabdomyosarcoma were performed. In one case, death occurred postoperatively, probably as a result of pulmonary embolism. One patient survived for 8 months, while the other is still alive after three years. Of two cases in which interscapulothoracic disarticulation was performed, survivals of 9 and 5 months were observed in subjects with fibrosarcoma in a mastectomy site and recurrent sarcoma of the humerus with ling metastases. Survival to 7 months was obtained in a case of sarcoma of the maxilla, while three patients with squama cell cancer of the mouth floor, chondrosarcoma of the mandible and botryoid sarcoma of the tonsillar fossa are still living after periods of 10 months to 2 yr. Though devoid of schematic indications, palliative demolition surgery can be considered in borderline cases where the operative risk is not high. Irrespective of "quantity", the "quality" of life remaining to the patients can be made compatible with the psychophysiological limits of the human personality.