Assessment of Prognostic Value of Classical Clinical-Pathological Factors in Hormone Receptor Positive Breast Carcinoma
J Segui, E Alcaraz, L Sanchez-Tejada, C Alenda, A Paya, G Peiro, FI Aranda. Universitary General Hospital, Alicante, Spain
Background: The prognosis of patients with estrogen receptor (ER) and/or progesterone receptor (PgR) positive breast carcinoma (BC) can be highly variable. The aim of this study was to investigate the clinical-pathologic features with potential prognostic significance such as age, tumor size, histologic grade, Bcl2, Ki67, Her2, p53 and immunophenotype in a series of BC hormone receptor (HR) positive.
Design: A total of 511 HR-positive BCs with axillary dissection and without neoadjuvant treatment were retrieved from the Surgical Pathology files. Median clinical follow-up of the patients was 78 months (range 15 to 245 months). Age ranged from 20 to 88 years (median 56 months). Histologic grade (HG) was assessed according to the Nottingham criteria. Immunohistochemical staining was performed for Bcl2 (cut-of 50%), ER (cut-of 10%), PgR (cut-off 10%), Ki67 (cut-off 20%), p53 (cut-off 20%) and Her2 (2+ and <30% 3+ confirmed by FISH). HR-positive/Her2-negative tumors were classified as luminal low-risk (Ki67/p53 <20%) and luminal high-risk (Ki67/p53 20%). Significant associations were identified using Chi-square and Fisher's exact test. Actuarial survival was calculated by the Kaplan-Meier method (log rank test) and multivariate Cox analysis was applied. A p-value <0.05 was considered significant.
Results: Tumors were predominantly of ductal type (93 %), <20 mm in size (57%) and negative lymph nodes (64 %). HG was G1 in 23%, G2 in 43% and G3 in 33%. Increased Ki67 was observed in 27% of tumors, Her-2-positive in 15%, p53 in 13% and low Bcl2 in 27%. High HG correlated with high Ki67, p53 positive, low Bcl2, Her2-positive and luminal high risk phenotypes (all p<0.05). Poor survival was seen for patients with larger tumors, of G3, positive lymph nodes, high expression of Ki67, low Bcl2, Her2-positive and high risk phenotypes (all p<0.02). However, a multivariate analysis revealed that only lymph node status, tumor size and HG were significant independent predictors of survival (all p<0.05).
Conclusions: Our findings in a series of BC with positive HR status support the usefulness of the immunophenotype classification. Nevertheless, classical pathological features such as HG, lymph node status and tumor size are the most powerful independent prognostic factors. Supported by grant FIS PI061488.
Wednesday, March 11, 2009 9:30 AM
Poster Session V # 1, Wednesday Morning