title: Hormone receptor status and mitotic activity as risk factors for recurrence and death in female breast carcinoma.
abstract: The estrogen (ER) and progesterone (PR) receptor status, volume corrected mitotic index (M/V index) and other classical prognostic factors were related to disease outcome in a series of 281 women with breast cancer followed up for over 8 years. The M/V index predicted recurrence only in ER+ or PR+ patients (p = 0.002-0.006). Similarly, the recurrence-free survival was related to M/V index only in ER+ (p = 0.0005) or PR+ (p less than 0.0001) patients. In survival analysis, ER+ (p = 0.0037) and PR+ (p less than 0.0001) patients were accurately divided into different prognostic groups by the M/V index, whereas in ER- and in PR-tumours the M/V index had only suggestive predictive value (p = 0.06-0.5). In N-tumours the M/V index predicted recurrence-free survival only in ER+ (p = 0.0228) and in PR+ (p = 0.0087) tumours. In survival analysis of N-tumours, the M/V index predicted cancer-related survival in ER+ (p = 0.0102) and in PR+ (p = 0.0014) tumours. In ER-/PR-, N-tumours, none of the variables tested had any prognostic value. The present results suggest that adjuvant hormone treatment might be indicated in ER+ or PR+ tumours with a M/V index greater than 10, regardless of the axillary lymph node status. The prognosis of ER+ or PR+ tumours with a M/V index less than 10 is favourable, the risk of recurrence being of the order of 15% only during the 10-year follow-up. Thus, the expensive and distressing adjuvant treatments could be omitted for these women with an inherently favourable disease outcome.
authors.affiliation: Department of Surgery, Kuopio University Hospital, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Aaltomaa
authors.forename: P
authors.initials: P
authors.lastname: Lipponen
authors.forename: M
authors.initials: M
authors.lastname: Eskelinen
authors.forename: V M
authors.initials: VM
authors.lastname: Kosma
authors.forename: S
authors.initials: S
authors.lastname: Marin
authors.forename: E
authors.initials: E
authors.lastname: Alhava
authors.forename: K
authors.initials: K
authors.lastname: Syrjänen
mesh_terms: D001943:Breast Neoplasms / Q000737:chemistry / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D008940:Mitotic Index; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis*; D011980:Receptors, Progesterone / Q000032:analysis*; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D011960:Receptors, Estrogen; D011980:Receptors, Progesterone