Prognostic factors for lymphedema after primary treatment of breast carcinoma.

BACKGROUND: Lymphedema of the arm is a serious consequence of breast carcinoma treatment. Postmastectomy lymphedema of the upper limb usually is related to certain risk factors such as axillary surgery, radiotherapy, obesity, venous outflow obstruction, delayed wound healing, and infection. The objective of the current study was to identify the risk factors for secondary lymphedema after breast carcinoma treatment. METHODS: A total of 1278 breast carcinoma patients, all of whom were residents of Florence area, Italy at the time of diagnosis and who were operated on by the same surgeon between 1989 and 1997, were included in the current analysis. The circumference of the upper arm was measured and lymphedema was defined as being present when an increase of > 5% of the sum differences between the two arms was found. The observed cumulative probability of lymphedema occurrence was estimated using the Kaplan-Meier method. The Cox proportional hazards models were fitted to assess the relative excess risk of lymphedema and to check for confusing factors. All patients with lymphedema who were living in the Florence area were referred to a specialist for treatment. RESULTS: Two hundred three cases of lymphedema of the ipsilateral arm were found (15.9%). The right arm was affected in 44.5% of the cases and the left arm in 55.5%. The risk of developing late lymphedema was found to be significantly related to a pathologic T2 classification (hazards ratio [HR] = 1.44; 95% confidence interval [95% CI], 1.06-1.94) and postoperative radiotherapy (HR = 1.35; 95%CI, 1.00-1.83). Patients who had > 30 lymph nodes removed were found to have a borderline increased risk of lymphedema (HR = 1.64; 95% CI, 0.99-2.74). Multivariate analysis identified postoperative radiotherapy (HR = 1.38; 95% CI, 1.02-1.86) and the number of lymph nodes removed (HR = 1.29; 95% CI, 1.04-1.59) to be independent predictors of lymphedema. CONCLUSIONS: The results of the current study demonstrated that the risk of lymphedema was correlated with the use of postoperative radiotherapy and the number of lymph nodes removed.

Prognostic value of breast cancer cytologic grading: a retrospective study of 213 cases.

The authors evaluate 213 consecutive breast cancer cases with positive fine-needle aspiration cytology. Cytologic smears were reviewed and classified according to a grading system. A correlation between cytologic grading and pathological stage (T and N category) was observed. Univariate analysis of 5-yr overall survival rate showed a significant negative association with prognosis only for G3 (90%) compared to G1 (72%) cases. Such prognostic correlation was no longer significant at multivariate (Cox) analysis adjusting for potential confounders such as T or N categories. The prognostic value of cytologic grading is limited and dependent on other classic prognostic indicators that are currently determined in breast cancer patients. Its practical value is negligible, as it does not improve the prognostic judgment.

Are postoperative fever and/or septic complications prognostic factors in colorectal cancer resected for cure?

The authors have examined the survival rate of 111 patients with colorectal cancer (Dukes' A, B, and C stages) treated by potentially curative surgery. In particular, the survival has been evaluated with regard to the appearance of postoperative fever and/or septic complications. The preliminary results demonstrate that these factors do not significantly influence the long-term prognosis.

Prognostic role of estrogen receptor determination in breast cancer.

The authors report on 283 primary, non-metastatic, breast cancer cases consecutively referred after surgery and followed-up from a minimum of 10 months to a maximum of 3.5 years. All cases were studied according to the presence of estrogen receptors (ER). ER presence was correlated with age and menstrual status, with ER+ cases more frequent in older patients. No correlation was found between ER and nodal status. Prognosis was evaluated in terms of disease-free survival at 2 years (actuarial method). No correlation between ER and survival was evident for N- cases, whereas a better prognosis was recorded for ER+N+ patients compared to ER-N+, although the difference was not statistically significant. The observed results are compared with recent literature data and agree with other recent reports, which did not confirm the previously undiscussed statement regarding the prognostic role of ER determination. According to these studies and to the present study, the prognostic role of ER determination seems at least questionable and particularly the postoperative adjuvant treatment of ER-N- cases should be reconsidered.

The role of chest X-ray in the follow-up of primary breast cancer.

The results of chest X-ray (CXR) survey in the follow-up of 1697 breast cancer patients are reviewed. Intrathoracic metastases (ITM) accounted for 26% of total first recurrences, but the rate dropped to 13% if isolated ITM and to 7% if asymptomatic isolated ITM were considered. Thus the role of CXR survey was limited to the detection of 39 cases of isolated ITM in the asympatomatic phase out of 7100 patients-year for a total number of 11,543 CXR examinations. Moreover, no difference in mean survival was observed if symptomatic and asymptomatic ITM were considered and survival was calculated from the time of first treatment. A small gain of 3 months, not statistically significant, of mean life from metastases diagnosis was recorded for asymptomatic cases, which is probably entirely due to the lead time effect of anticipated diagnosis. CXR survey in breast cancer follow-up may add to the knowledge of the natural history of the disease, but it appears worthless for other purposes. Thus the high costs related to CXR survey may be unacceptable, and a randomized study on the role of CXR is suggested and justified.