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Ann Oncol ; 24(9): 2284-91, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23704202

ABSTRACT

BACKGROUND: In a retrospective study on node-negative breast cancer, a prognostic index consisting of a proliferation factor, S-phase fraction (SPF), progesterone receptor status (PR), and tumour size identified one-third of patients as high risk, with a sixfold increased risk of breast cancer death. This prospective multicenter cohort study was set up to validate the index. PATIENTS AND METHODS: In 576 T1-2N0 patients <60 years, prospective analyses of PR and SPF were carried out. High risk was defined as ≥2 of the following: size >20 mm, PR-negativity, and high SPF (in the absence of SPF, Bloom-Richardson grade 3). Median follow-up was 17.8 years. RESULTS: Thirty-one percent were high risk. In univariate analysis, the index was prognostic for breast cancer-specific survival after 5 years [hazard ratio (HR) = 4.7, 95% confidence interval (95% CI) 2.5-8.9], 10 years (HR = 2.2, 95% CI 1.5-3.3), and 15 years (HR = 1.7, 95% CI 1.2-2.5), and remained significant after adjustment for adjuvant medical treatment and age. In the 37% of patients with no risk factors, only one patient died of breast cancer the first 5 years. CONCLUSIONS: This prospective study validates a prognostic index consisting of a proliferation factor, PR-status, and tumour size. The index may be helpful for prognostic considerations and for selection of patients in need of adjuvant therapy.


Subject(s)
Biomarkers, Tumor/metabolism , Breast Neoplasms/mortality , Mitotic Index , Receptors, Progesterone/metabolism , S Phase/physiology , Breast Neoplasms/drug therapy , Breast Neoplasms/surgery , Cell Proliferation , Cohort Studies , Disease-Free Survival , Female , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Middle Aged , Prospective Studies , Survival
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