ABSTRACT
We evaluated with long-term follow-up, the prognostic value of the mitotic activity index (MAI) and the volume corrected mitotic index (M/V-index) compared with that of the histological grade in breast cancer patients not treated with adjuvant systemic therapy. Of 739 consecutive patients living in the city of Nijmegen, the Netherlands, 477 patients with primary unilateral breast cancer were not treated with adjuvant systemic therapy and eligible for the study. In multivariate survival analyses the MAI and M/V-index showed similar hazard ratios (HRs) compared to HRs of histological grade for overall survival (OS) (HR: 1.45, 1.48, and grade II versus grade I (GII/GI) 1.34, grade III versus grade I (GIII/GI) 1.53, respectively) and for breast cancer specific survival (BCSS) (HR: 1.27, 1.57, and (GII/GI) 1.57 (GIII/GI) 2.32, respectively). Other independent prognostic variables for OS and BCSS were age at diagnosis, tumour size, and number of positive lymph nodes. In the present study with long term follow-up, we compared the prognostic value of mitotic activity with that of histological grade and found no advantage for the mitotic activity in predicting either BCSS or OS and concluded that histological grade and the mitotic activity were equally informative in predicting patient outcome. As histological grade is a well established and widely used prognosticator we do not have arguments to replace the histological grade by the mitotic indices MAI or M/V-index.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Mitotic Index , Adult , Aged , Aged, 80 and over , Breast Neoplasms/mortality , Breast Neoplasms/therapy , Carcinoma/mortality , Carcinoma/pathology , Carcinoma/therapy , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/therapy , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Middle Aged , Netherlands/epidemiology , Prognosis , Proportional Hazards Models , Retrospective Studies , Risk FactorsABSTRACT
In this study we examined whether the well-known winter excess of schizophrenic births exists among Dutch schizophrenia patients when statistical artifacts such as the age-incidence and age-prevalence effects are avoided and, if so, whether the seasonal preovulatory release of overripe ovum (SPrOO) hypothesis, that is, seasonally bound ovopathy, might be an explanation for this excess. We analyzed the month-of-birth distribution of 1,037 Dutch schizophrenia patients born between 1962 and 1966 and first admitted to a psychiatric hospital between 1978 and 1990 by the so-called window analysis to avoid the artifacts mentioned. The results show a winter excess of births among Dutch schizophrenia patients, even when statistical artifacts are avoided, and that the SPrOO hypothesis might be an explanation for this excess. Further research is needed to support the hypothesis that ovopathy, either seasonally bound or not, could be involved in the etiology of schizophrenia.
