Prediction of survival in breast cancer. Principles and current status of hormone receptors and DNA content as prognostic factors.
The probability of survival in breast cancer patients is the net result of a number of factors. The presence of distant metastases, mostly occult, the size and growth rate of the systemic tumour burden and causes of mortality other than breast cancer are major determinants of the outcome after primary treatment. We emphasize the need for separating these different options as a prerequisite for individualized primary treatment and follow-up and also for a rational selection of patients for adjuvant therapy. Several lines of evidence suggest that the oestrogen receptor (ER) content reflects the growth rate of the tumour cells rather than their proneness to metastasize. A high ER content in the primary tumour would accordingly predict an extended disease-free survival and a relatively long survival after relapse rather than a low ultimate frequency of distant disease and mortality. Available data indicate that the progesterone receptor concentration extends--and possibly replaces--this prognostic implication of ER. Analyses of the clinical course in relation to the DNA content of the tumour cells are still at an early stage, but preliminary results point to a poorer prognosis in aneuploid than in euploid tumours, especially among patients with breast cancer of an early stage. It remains to be established, however, whether the distribution of the nuclear DNA content is mainly an expression of tumour growth rate or whether it is also an indicator of metastatic potential, and thus of long-term survival; and if so, whether it has this capacity independently of established prognostic factors such as axillary node status, tumour size and morphological characteristics.
D001943:Breast Neoplasms / Q000032:analysis / Q000401:mortality* / Q000473:pathology; D004273:DNA, Neoplasm / Q000032:analysis; D005260:Female; D006801:Humans; D009362:Neoplasm Metastasis; D011336:Probability; D011379:Prognosis; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis
D004273:DNA, Neoplasm; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone