In:
Analytical Cellular Pathology, Hindawi Limited, Vol. 28, No. 5-6 ( 2006-01-01), p. 295-303
Abstract:
Background : Adjuvant systemic chemotherapy (ASCT) in lymph node-negative breast (LN−) cancers improves survival. The majority of (LN−) patients receive ASCT when the St. Gallen criteria or its modifications are used, as accurate identifiers which patients benefit from ASCT are lacking. This may imply over-treatment in many patients. Aim : To evaluate which patients or primary tumor factors predict ASCT success. Material and method: Retrospective analysis by single and multivariate survival analysis of clinical and tumor characteristics in (LN−) breast cancers 〈 55 years, related to ASCT ( n = 125) or-not ( n = 516). Results : The two patient groups did not differ in age, tumor diameter, grade, type, number of mitoses and other factors. Fourteen-year survival for the ASCT and non-ASCT patients was 83% and 74% (Hazard Ratio = HR = 0.33; p 〈 0.0001, 9% absolute = 12% relative difference). Subgroup analysis showed that the recurrence-free survival = RFS of ASCT treated vs. non-treated patients differed in patients with grade 1 cancers ( p = 0.008), grade 2 cancers ( p = 0.004), grades 3 ( p = 0.02), tumors under and ≧2 cm ( p = 0.001 and 0.0002), oestrogen receptor-positive or -negative tumors ( p = 0.003, 0.04), MAI 〈 10 and ≧10 ( p = 0.005, 0.003) and fibrotic focus absent ( p = 0.002). With multivariate analysis the most important predictor of ASCT effect was the MAI. In patients with slowly proliferating tumors (MAI 〈 3) no advantage was found between patients treated-or-not with adjuvant chemotherapy (RFS = 92% and 91%, p = 0.13, p = 0.63 for overall survival), contrasting those with MAI ≧ 3 ( p = 0.0001; HR = 0.32, 95% CI 0.18–0.58). Conclusion : MAI is the strongest predictor of adjuvant systemic chemotherapy success. In patients with MAI 〈 3 (31% of all patients), ASCT does not improve survival.
Type of Medium:
Online Resource
ISSN:
2210-7177
,
2210-7185
Language:
English
Publisher:
Hindawi Limited
Publication Date:
2006
detail.hit.zdb_id:
2584078-2
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