Low proliferative rate of invasive node-negative breast cancer predicts for a favorable outcome: a prospective evaluation of 669 patients.
This study was designed to compare outcome in terms of disease-free survival (DFS) in women with histologically negative axillary lymph nodes and documented low proliferative rate cancer to other well-defined prognostic factors including type of adjuvant treatment. Between 1988 and 1998, we studied 669 patients with invasive node-negative breast cancer up to 5 cm in size and low proliferative rate measured by flow cytometry to determine S-phase fraction (SPF) or by histochemistry (Ki67/MIB1). At a median follow-up of 53 months, 5-year DFS for the entire group was 94% and did not differ significantly by type of systemic adjuvant treatment: none (133 patients, 95% DFS), tamoxifen (441 patients, 94% DFS), or chemotherapy with doxorubicin and cyclophosphamide (95 patients, 92% DFS). In a multivariate prognostic factor analysis, only tumor size was significant; 5-year DFS was 96% for T1N0 cancer versus 89% for T2N0 cancer (P = 0.01). We have prospectively confirmed that a low rate of proliferation as measured by SPF or MIB1 determination confers an excellent prognosis in invasive node-negative breast cancer up to 5 cm in size, regardless of adjuvant treatment.
Jones
S
S
Charles A. Sammons Cancer Center, Baylor University Medical Center, Fifth Floor-Research, Texas Oncology, P.A., 3535 Worth Street, Dallas, TX 75246, USA. Steve.Jones@usoncology.com
Clark
G
G
Koleszar
S
S
Ethington
G
G
Mennel
R
R
Paulson
S
S
Brooks
B
B
Kerr
R
R
Denham
C
C
Savin
M
M
White
C
C
Blum
J
J
Kirby
R
R
Stone
M
M
Pippen
J
J
Kitchens
L
L
George
T
T
Cooper
B
B
Peters
G
G
Knox
S
S
Grant
M
M
Cheek
H
H
Jones
R
R
Kuhn
J
J
Lieberman
Z
Z
Savino
D
D
Rietz
C
C
D000328:Adult; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D034961:Antigens, Nuclear; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000401:mortality / Q000473:pathology*; D003520:Cyclophosphamide / Q000627:therapeutic use; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000378:metabolism; D008198:Lymph Nodes; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009687:Nuclear Proteins / Q000378:metabolism; D011446:Prospective Studies; D016196:S Phase; D015996:Survival Rate; D013629:Tamoxifen / Q000627:therapeutic use
D000903:Antibiotics, Antineoplastic; D034961:Antigens, Nuclear; D018906:Antineoplastic Agents, Alkylating; D018931:Antineoplastic Agents, Hormonal; D019394:Ki-67 Antigen; D009687:Nuclear Proteins; D013629:Tamoxifen; D004317:Doxorubicin; D003520:Cyclophosphamide