Is the Histologic Tumor Grade an Important Prognostic Factor in Small (T1, T2) Node-Negative Breast Adenocarcinomas?
MS Purdom, ML Cibull, LM Samayoa, TD Stratton, EH Romond, PC McGrath, RG Karabakhtsian. University of Kentucky, Lexington, KY
Background: Prognosis of invasive breast cancer correlates with tumor grade (G). While reporting it as low (G1), intermediate (G2) and high grade (G3) is recommended by AJCC staging system, the TNM classification does not incorporate this data. For large tumors (T3, T4) G may be clinically irrelevant. However, the same may not hold true for small (T1, T2) tumors. This retrospective study analyzes the clinical outcome in patients with small node-negative (N0) carcinomas based on tumor G.
Design: 111 excision pathology reports from patients with T1N0 and T2N0 breast tumors and known variables were retrieved from 1995 to 2007. Tumors included 10 T1a, 23 T1b, 45 T1c, and 33 T2. Clinical follow-up (FU) ranged from 7 to 152 months (mean interval 56 months). Lymphovascular invasion (LVI), hormonal and Her-2/neu status, and FU data from Tumor Registry were analyzed based on tumor size and G.
Results: 78 T1 tumors included 15 G1, 38 G2 and 25 G3. On FU 71 (93%) patients were alive and 3 deceased without disease, one died (G1) and another was alive (G2) with disease. 33 T2 tumors included 1 G1, 16 G2 and 16 G3. On FU 27 (82%) patients were alive and 2 deceased without disease, 3 died (all ER-, including one triple-) and one was alive with disease; all 4 had G3 tumors, including two with LVI. Of T1 patients 38% and 24% had received hormonal and chemotherapy, respectively, as 33% and 67% in T2 (2 of 4 with disease had chemotherapy, and 2 did not).
Clinical Outcome by Tumor Grade in Small (T1,T2) Node-Negative Breast Adenocarcinomas*Excludes 2 alive, status unknown **Clinical outcome includes patients living and deceased ***p value, one-tailed Fisher exact test
|Tumor Size||T1 (N=76)*||T2 (N=33)|
|Clinical Outcome**||Clinical Outcome**|
|Without Disease||With Disease||Without Disease||With Disease|
|Tumor Grade||N (%)||N (%)||p***||N (%)||N (%)||p***|
|G1-G2||50 (66%)||2 (3%)||17 (52%)||0 (0%)|
|G3||24 (31%)||0 (0%)||0.46||12 (36%)||4 (12%)||0.04|
Conclusions: 1) Regardless of histologic G, the overall prognosis for T1N0 and T2N0 breast adenocarcinomas is very good. 2) In this small study, there is no evidence that higher G significantly impacts the clinical outcome in T1N0 tumors. 3) In T2 tumors, our data suggests that histologic G might be prognostically significant and relevant in influencing treatment decisions.
Tuesday, March 10, 2009 1:00 PM
Poster Session IV # 14, Tuesday Afternoon