- Email: [email protected]
Prognostic factors for the course of metastatic breast cancer
1400
Abstracts
6.
TBB IMPORTANCEOF THE FAMILY HISTORY IN BWAST CANCER. 2 1 Weber W. , Ott J. and Mller Sj.1 1 Laboratoryof Hums" Genetics, Departmentof Research,Uni-
R careful analysis of the survival rates with regard to lymphnode involvementshows the following result : 25 yeses NED DOD
44 21 30 13
a % % %
2Q 44 48 74
% % % $
Pedigree data are systematicallycollected from patients with newly diagnosedmalignant diseases in hospital services and private practice in Basel. A registry for cancer-pronefsmilies is established.
Today we depend for the treatment (adjuvantor complementary) on an exact staging of the AL. But where is the place of the surgico-pathologicalstaging of the IML ? Is there the missing link that would explain the decrease in expected survival rates for low stage breast cancer ?
Our preliminarydata are in agreementwith the results reported by Dr. H.T. Lynch who has show" that a family history coupled with histologicverificationcan provide the physician a powerful tool for the identificationof patients genetically susceptibleto cancer (JAMA 242: 1268-1272,1979).
\ \ % 8
\ \ li %
AL AL AL RL
A" excessiveaccumulationof breast cancer was observed in the familiesof 3 of 30 interviewedfemale breast cancer patients. In 2 other families breast cancer was associatedwith adenocarcinomasof different organs. Healthy female relatives of breast cancer patients have repeatedlyconsulted us for advice on the value and risk of prophylacticmastectomy.
33 21 11 12
33 53 56 73
versity Clinics, Cantnnal Hospital,CH-4031 Basel,Switzerland. 2 vice Director, Statisticaloffice of the City of Zorich,
Switzerland.
neg/1uL neg pos/1ML neg neq/1ML pas pos/1ML pas
20 years NED DOD
9.
PRDGNDSTICFACTORS FOR THE COURSE OF METASTATICBREAST CANCER. K.W.Brunner,M.F.Fey, Institute for Medical O"col"qy, 1nse1spita1,CH-3010 Bern. 7. HISTOPATHOLOGICALRISK EVALUATIONIN BREAST CANCER. K.Biirki, A.Zimmermann,R.Kraft, B.Roos. Instituteof Pathology, Universityof -Ii-Eern, Switzerland. The diagnosis "breast cancer" ss such does not suffice for clinicopathologicsl evaluationsince it covers different diseases in different stages of development.In fact, inherent pathologicaland biological characteristicsof various types of mammary cancer srs not only of importancefor prognosis; in at least a number of csses they can also influence the therapist'smanagement.Pathologicalparametersdetermining prognosis comprise: degree ana pattern of spreading,in particularto regional lymph "odes; primary tumor size; differentiation(i.e. histologicalsnd nuclear grade); histological type of the tumor, tumor necrosis, border (circumscribed or stellate)and vascular invasion;primary site; "biochemicsl'character (includinghormonal responsiveness); multicentricityetc. Current classificationsof breast cancer s.rebased on morphologicdescriptiveand/or presumed histogenetic criteria.Several reports attest the favorableclinical course of certain histologictypes, Viz. medullary, tubular, mutinous, comedo and adenoid cystic carcinomasas compared to other types. The significanceof so-calledcarcinomas-in situ is still disputed.Risk evaluation seems to be mnre reliable if histologicaltyping and grading s.recombined with parsmeters mentioned above, particularlyon the extent of the disease. Additionalparameters such as cellular kinetics, cell sizing, elastosis in the tUrnOrbed, tumor-host interactions (includingspecific immune reactions and "on-specifichost resistance)have met with increasinginterest in recent years. The prognosticusefulness of snme of these complementarypsrameters remains to be examined in more detail.
Various factors determiningtotal survival from the time of initial diagnosis, the median survival after appearanceof metsstases and survival from the onset of chemotherapywere studied in 405 patients treated in SAKK protocolsbetween 1968 snd 1976. The site of the first metsstatic lesion seems to be a" important factor in regard t" overall survival from the time of diagnosis.Four categoriesof metaststic types could be establishedwith significantlydifferentmedian survival times. According t" the category, total survival varied from 19 to 58 months. Differencesin survival times after appearanceof the first metastasis,or following institutionof chemotherapy were much less pronounced.These were determinedprimarily by 3 types of metastases as well as the time interval from the Very first treatment to the first metastasis,but especially by the response t" treatment in the metsstaticphase of disease. Factors which clearly influencedthe cnurse of metastaticdisease in the past are rapidly losing their significancein the face of modern chemotherapy.It appears that the mnst importanteffect of chemotherapyis tc improve the median survival of prognosticallyunfavorablecases so the course approachesthat of patients with a spontaneous favorablecourse of disease.
IO.
OESTROGENAND PROGESTERONERECEPTORS IN BREAST CANCER CLINICAL CORRELATIONAND PROGNOSTICSIGNIFICANCEAFTER 3 YEARS EXPERIENCE. G. Ross&, C. Depierre,C. Guelpa and R. Egeli, H6pital Cantonal UNiversitaire,1211 Geneva 4, Switzerland. The interest for hormonal receptorsmeasurementsin selecting patients for endocrinetherapy is well established. Several authors have also reported on the relation between absence of receptorsand bad prognosis.
8. INFLUENCEOF THE INTERNAL MAMMARY LYMPHNODES (IML) ON LONG TERM SURVIVAL (20 & 25 YEARS) IN WOWiN WITH BREAST CANCER. R.A.Egsliand J.A.Urban, MSicCC,New York, N.Y. 10021, USA. series of 784 patients with breast cancer who underwent extended radical ma&e&any is presented. Most often the tumor wss located either in the inner quadrants (88 %) or central (8 %). A postsurgicalanalysis of the axillary lymphnodes (AL) and the II& revealed that the AL were positive in 44 \ of all the cases and the IML in 30 %. In 15 % the IML were found to bs involved by metastatic spread when the AL were negative. 155 pts were eligible for a 25 year survival analysisi of these 50 8 died of disease KXJD1 and 22 \ were still alive without any signe of disease (NED) 25 years after the operation. 327 pts were available for s 20 year survival analysis; of these 43 8 were COD and 30 8 NED. A
We measured oestrogen and progesteronereceptors in 600 patientswith breast cancer for the last three years. The method used was the Dextran-coatedcharcoal assay. Survival rate without relapse in patientswith oestrogen receptors is 07 % with a follow up period ranging from 12 to 36 nmnths. In the absence of oestrogen receptors the survival rate without relapse falls to 65 % for the same period of observation,regardlessof TNM staging. In our series death rate of patients without oestrogen receptors is 23 % compared to only 4 % in patientswith oestrogen receptors. Relations between presence or absence of hormonal receptors regardingto clinical staging, tumor histology,menopausal status have also been analysed. This study was partly supported by the Geneva League Against Cancer and by the Swiss Group (SAKK).
Abstracts
6.
TBB IMPORTANCEOF THE FAMILY HISTORY IN BWAST CANCER. 2 1 Weber W. , Ott J. and Mller Sj.1 1 Laboratoryof Hums" Genetics, Departmentof Research,Uni-
R careful analysis of the survival rates with regard to lymphnode involvementshows the following result : 25 yeses NED DOD
44 21 30 13
a % % %
2Q 44 48 74
% % % $
Pedigree data are systematicallycollected from patients with newly diagnosedmalignant diseases in hospital services and private practice in Basel. A registry for cancer-pronefsmilies is established.
Today we depend for the treatment (adjuvantor complementary) on an exact staging of the AL. But where is the place of the surgico-pathologicalstaging of the IML ? Is there the missing link that would explain the decrease in expected survival rates for low stage breast cancer ?
Our preliminarydata are in agreementwith the results reported by Dr. H.T. Lynch who has show" that a family history coupled with histologicverificationcan provide the physician a powerful tool for the identificationof patients genetically susceptibleto cancer (JAMA 242: 1268-1272,1979).
\ \ % 8
\ \ li %
AL AL AL RL
A" excessiveaccumulationof breast cancer was observed in the familiesof 3 of 30 interviewedfemale breast cancer patients. In 2 other families breast cancer was associatedwith adenocarcinomasof different organs. Healthy female relatives of breast cancer patients have repeatedlyconsulted us for advice on the value and risk of prophylacticmastectomy.
33 21 11 12
33 53 56 73
versity Clinics, Cantnnal Hospital,CH-4031 Basel,Switzerland. 2 vice Director, Statisticaloffice of the City of Zorich,
Switzerland.
neg/1uL neg pos/1ML neg neq/1ML pas pos/1ML pas
20 years NED DOD
9.
PRDGNDSTICFACTORS FOR THE COURSE OF METASTATICBREAST CANCER. K.W.Brunner,M.F.Fey, Institute for Medical O"col"qy, 1nse1spita1,CH-3010 Bern. 7. HISTOPATHOLOGICALRISK EVALUATIONIN BREAST CANCER. K.Biirki, A.Zimmermann,R.Kraft, B.Roos. Instituteof Pathology, Universityof -Ii-Eern, Switzerland. The diagnosis "breast cancer" ss such does not suffice for clinicopathologicsl evaluationsince it covers different diseases in different stages of development.In fact, inherent pathologicaland biological characteristicsof various types of mammary cancer srs not only of importancefor prognosis; in at least a number of csses they can also influence the therapist'smanagement.Pathologicalparametersdetermining prognosis comprise: degree ana pattern of spreading,in particularto regional lymph "odes; primary tumor size; differentiation(i.e. histologicalsnd nuclear grade); histological type of the tumor, tumor necrosis, border (circumscribed or stellate)and vascular invasion;primary site; "biochemicsl'character (includinghormonal responsiveness); multicentricityetc. Current classificationsof breast cancer s.rebased on morphologicdescriptiveand/or presumed histogenetic criteria.Several reports attest the favorableclinical course of certain histologictypes, Viz. medullary, tubular, mutinous, comedo and adenoid cystic carcinomasas compared to other types. The significanceof so-calledcarcinomas-in situ is still disputed.Risk evaluation seems to be mnre reliable if histologicaltyping and grading s.recombined with parsmeters mentioned above, particularlyon the extent of the disease. Additionalparameters such as cellular kinetics, cell sizing, elastosis in the tUrnOrbed, tumor-host interactions (includingspecific immune reactions and "on-specifichost resistance)have met with increasinginterest in recent years. The prognosticusefulness of snme of these complementarypsrameters remains to be examined in more detail.
Various factors determiningtotal survival from the time of initial diagnosis, the median survival after appearanceof metsstases and survival from the onset of chemotherapywere studied in 405 patients treated in SAKK protocolsbetween 1968 snd 1976. The site of the first metsstatic lesion seems to be a" important factor in regard t" overall survival from the time of diagnosis.Four categoriesof metaststic types could be establishedwith significantlydifferentmedian survival times. According t" the category, total survival varied from 19 to 58 months. Differencesin survival times after appearanceof the first metastasis,or following institutionof chemotherapy were much less pronounced.These were determinedprimarily by 3 types of metastases as well as the time interval from the Very first treatment to the first metastasis,but especially by the response t" treatment in the metsstaticphase of disease. Factors which clearly influencedthe cnurse of metastaticdisease in the past are rapidly losing their significancein the face of modern chemotherapy.It appears that the mnst importanteffect of chemotherapyis tc improve the median survival of prognosticallyunfavorablecases so the course approachesthat of patients with a spontaneous favorablecourse of disease.
IO.
OESTROGENAND PROGESTERONERECEPTORS IN BREAST CANCER CLINICAL CORRELATIONAND PROGNOSTICSIGNIFICANCEAFTER 3 YEARS EXPERIENCE. G. Ross&, C. Depierre,C. Guelpa and R. Egeli, H6pital Cantonal UNiversitaire,1211 Geneva 4, Switzerland. The interest for hormonal receptorsmeasurementsin selecting patients for endocrinetherapy is well established. Several authors have also reported on the relation between absence of receptorsand bad prognosis.
8. INFLUENCEOF THE INTERNAL MAMMARY LYMPHNODES (IML) ON LONG TERM SURVIVAL (20 & 25 YEARS) IN WOWiN WITH BREAST CANCER. R.A.Egsliand J.A.Urban, MSicCC,New York, N.Y. 10021, USA. series of 784 patients with breast cancer who underwent extended radical ma&e&any is presented. Most often the tumor wss located either in the inner quadrants (88 %) or central (8 %). A postsurgicalanalysis of the axillary lymphnodes (AL) and the II& revealed that the AL were positive in 44 \ of all the cases and the IML in 30 %. In 15 % the IML were found to bs involved by metastatic spread when the AL were negative. 155 pts were eligible for a 25 year survival analysisi of these 50 8 died of disease KXJD1 and 22 \ were still alive without any signe of disease (NED) 25 years after the operation. 327 pts were available for s 20 year survival analysis; of these 43 8 were COD and 30 8 NED. A
We measured oestrogen and progesteronereceptors in 600 patientswith breast cancer for the last three years. The method used was the Dextran-coatedcharcoal assay. Survival rate without relapse in patientswith oestrogen receptors is 07 % with a follow up period ranging from 12 to 36 nmnths. In the absence of oestrogen receptors the survival rate without relapse falls to 65 % for the same period of observation,regardlessof TNM staging. In our series death rate of patients without oestrogen receptors is 23 % compared to only 4 % in patientswith oestrogen receptors. Relations between presence or absence of hormonal receptors regardingto clinical staging, tumor histology,menopausal status have also been analysed. This study was partly supported by the Geneva League Against Cancer and by the Swiss Group (SAKK).