The Favorable Prognostic Significance of Surgery-Induced Hyperprolactinemia in Node-Positive Breast Cancer Patients: Ten-Year Disease-Free Survival Results

It has been shown that each manipulation of the mammary region, including breast surgery, may stimulate prolactin secretion. However, it has also been observed that in more than 50% of breast cancer patients surgical removal of the tumor is not followed by enhanced prolactin secretion. This might be indicative of an altered psychoneuroendocrine control of the mammary gland, which could lead to the onset of more biologically aggressive breast cancer. In fact, surgery-induced hyperprolactinemia has been proven to be associated with a better prognosis in terms of survival in node-negative breast cancer patients. The present study was performed to investigate the impact of postoperative hyperprolactinemia on the disease-free survival (DFS) of breast cancer patients with axillary node involvement. The study included 100 consecutive node-positive breast cancer patients who were followed for at least 10 years. Surgery-induced hyperprolactinemia occurred in 45/100 (45%) patients without any significant correlation with the main prognostic variables including number of involved nodes and ER status. The two groups of patients received the same adjuvant therapies. After a median follow-up of 151 months, the recurrence rate in patients with surgery-induced hyperprolactinemia was significantly lower than in patients with no postoperative hyperprolactinemia (23/45 vs 43/55, p<0.01). Moreover, DFS was significantly longer in hyperprolactinemic patients than in patients who had no enhanced secretion of prolactin postoperatively. In agreement with the results described previously in node-negative breast cancer, our study demonstrates the favorable prognostic significance of surgery-induced hyperprolactinemia in terms of DFS duration also in breast cancer patients with axillary node involvement, independent of the other well-known prognostic variables, thereby confirming that the psychoneuroendocrine status of cancer patients may influence the prognosis of their disease.

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Incidence and Prognostic Significance of Complete Axillary Downstaging After Primary Chemotherapy in Breast Cancer Patients With T1 to T3 Tumors and Cytologically Proven Axillary Metastatic Lymph Nodes

Journal of Clinical Oncology ◽

10.1200/jco.2002.20.5.1304 ◽

2002 ◽

Vol 20 (5) ◽

pp. 1304-1310 ◽

Cited By ~ 128

Author(s):

Roman Rouzier ◽

Jean-Marc Extra ◽

Jerzy Klijanienko ◽

Marie-Christine Falcou ◽

Bernard Asselain ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Prognostic Significance ◽

Disease Free Survival ◽

Primary Chemotherapy ◽

Axillary Lymph ◽

Breast Cancer Patients ◽

Distant Disease ◽

Free Survival ◽

Disease Free

PURPOSE: To determine the incidence and prognostic significance of eradication of cytologically proven axillary lymph node metastases in breast cancer patients treated with primary chemotherapy. PATIENTS AND METHODS: Between January 1985 and December 1994, 152 breast cancer patients with invasive T1 to T3 tumors and axillary metastases cytologically proven by fine-needle sampling underwent primary chemotherapy followed by lumpectomy or mastectomy, level I and II axillary lymph node dissection, and irradiation. We studied pathologic complete responses (pCRs) of axillary nodes and breast tumors, as well as predictors of distant metastases. RESULTS: Thirty-five patients (23%) had axillary pCRs, and 20 patients (13.2%) had pCRs of primary breast tumors. Scarff-Bloom-Richardson grade 3 tumors (P = .04) and a clinical response to chemotherapy ≥ 50% (P = .003) were associated with negative axillary status at dissection. An initial tumor size ≤ 3 cm (63 patients) was associated with pCR of the primary tumor (P = .02) but not with complete histologic clearance of axillary lymph nodes. The median length of follow-up was 75 months. In the univariate analysis, age greater than 40 years (P = .003), absence of residual nodal disease (P = .01), and pCR of the tumor (P = .05) were associated with better distant disease-free survival. Five-year distant disease-free survival rates were 73.5% ± 14.9% among patients with no involved nodes at the time of surgery and 48.7% ± 9.2% among patients with residual nodal disease. In the multivariate Cox regression analysis, parameters associated with poor distant disease-free survival were age ≤ 40 years (P = .002), persistence of nodal involvement (P = .03), and S-phase fraction greater than 4% (P = .02). CONCLUSION: Our results suggest that axillary status is a better prognostic factor than response of the primary tumor to primary chemotherapy.

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Relationship between cathepsin-D content and disease-free survival in node-negative breast cancer patients: a meta-analysis

British Journal of Cancer ◽

10.1038/bjc.1997.442 ◽

1997 ◽

Vol 76 (5) ◽

pp. 661-666 ◽

Cited By ~ 66

Author(s):

G Ferrandina ◽

G Scambia ◽

F Bardelli ◽

P Benedetti Panici ◽

S Mancuso ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cathepsin D ◽

Meta Analysis ◽

Disease Free Survival ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Disease Free

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Relative worth of estrogen or progesterone receptor and pathologic characteristics of differentiation as indicators of prognosis in node negative breast cancer patients: findings from National Surgical Adjuvant Breast and Bowel Project Protocol B-06.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.7.1076 ◽

1988 ◽

Vol 6 (7) ◽

pp. 1076-1087 ◽

Cited By ~ 276

Author(s):

B Fisher ◽

C Redmond ◽

E R Fisher ◽

R Caplan

Keyword(s):

Breast Cancer ◽

Progesterone Receptor ◽

Cancer Patients ◽

Systemic Therapy ◽

Disease Free Survival ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Disease Free

This study correlates the disease-free survival (DFS), distant disease-free survival (DDFS), and survival (S) of 1,157 histologically node negative breast cancer patients with the estrogen and/or progesterone receptor (ER, PR) and with the nuclear or histologic grade (NG, HG) of their tumors. All were treated by operation without systemic adjuvant therapy. The DFS, DDFS, and S were significantly greater (P = .005, .004, less than .001) in patients with ER positive than ER negative tumors but the magnitude of the differences after 5 years of follow-up was slight (8% in both DFS and DDFS and 10% in S). Differences of that magnitude are insufficient to discriminate clearly between patients who should or should not receive systemic therapy. As with ER, there were outcome differences in favor of PR positive tumors but only in S was the difference significant (8% at 5 years; P = .002). When combined with ER, PR made no independent contribution in the outcome prediction. Regression analysis indicated that NG was the most important single marker of outcome. The prognosis of women with unknown ER or PR was equivalent to or better than that in those with ER or PR positive tumors. This finding seems to be related to tumor size in that a higher proportion of tumors with unknown receptors were less than 1.0 cm, thus having insufficient tissue for analysis. Our findings disclose that in node negative breast cancer patients, NG is a better marker of prognosis than is tumor ER, and that PR is of little or no value. Tumor NG may also be useful for selecting the type of systemic therapy to be used in these patients.

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692 Relationship between DNA ploidy and disease-free survival in node-negative breast cancer patients

European Journal of Cancer ◽

10.1016/0959-8049(95)95942-y ◽

1995 ◽

Vol 31 ◽

pp. S144

Author(s):

A. Niwinska

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Dna Ploidy ◽

Disease Free Survival ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Disease Free

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The analyses of disease free survival and overall survival in premenopausal and postmenopausal axillary node negative breast cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10757 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10757-10757

Author(s):

N. D. Bajic ◽

D. D. Scepanovic

Keyword(s):

Breast Cancer ◽

Overall Survival ◽

Prognostic Factors ◽

Disease Free Survival ◽

Axillary Node ◽

Breast Cancer Patients ◽

Free Survival ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Significant Difference

10757 Background: The aim of this study was to analyse in which order known traditional prognostic factors predict disease free survival (DFS) and overall survival (OS) in breast cancer patients (pts) who are patohystologicaly axillary node negative. Methods: From 1998 till 2004, 258 patients were treated of axillary node negative breast cancer. We analysed 3 and 5 years (yrs) DFS and 3 and 5 yrs OS for all patients as well as for premenopausal (96 pts, 37%) and postmenopausal (162 pts, 63%). The mean follow-up time for DFS was 60 months (mo) (min 30, max 136 mo) and for OS was 66 mo (min 36, max 140 mo). As prognostic factors for DFS and OS, age, tumour size, HG as well as adjuvant treatment (locoregional and systemic) were analysed accordingly. Fifty two patients (20%) were HG1 while 190 pts (74%), were HG2 & 3; 30 pts (11%) had tumour up to 1cm and 157 pts (61%) had tumours up to 3cm and 71 pts (28%) above 3cm. Radical mastectomy was performed in 92 pts (36%) while conservative surgery were performed in 166 pts (64%). Systemic therapy was applied in 224 pts (87% of which 57% were treated with hormonotherapy). Results: 3 yrs DFS for 258 treated pts were 87% - there was no statistically significant difference among pre- and postmenopausal pts; 5 yrs DFS were 73% with no statistically significant difference among pre- and postmenopausal group of pts (p > 0.05). 3 yrs overall survival were 94% and 5 yrs 80% with no statistically significant difference among pre- and postmenopausal pts (p > 0.05). There were statistically different DFS and OS among those pts treated with adjuvant radiotherapy as well as for those with adjuvant systemic therapy in both group of pts (p < 0.001). Also as independent prognostic factor for DFS and OS were HG (Cox regression model). Conclusions: Although, HG and adjuvant therapy are the most important prognostic factors for DFS and OS in premenopausal and postmenopausal patients, we found that there is no statistically significant difference between the groups respectively. However, life-expectancy for premenopausal patients is longer. Therefore further adjuvant therapy research is needed to achieve better DFS and OS in this group of pts. No significant financial relationships to disclose.

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Prognostic significance of S-phase fraction in good-risk, node-negative breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.1992.10.3.428 ◽

1992 ◽

Vol 10 (3) ◽

pp. 428-432 ◽

Cited By ~ 83

Author(s):

G M Clark ◽

M C Mathieu ◽

M A Owens ◽

L G Dressler ◽

L Eudey ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Prognostic Significance ◽

Axillary Node ◽

S Phase ◽

Phase Fraction ◽

Breast Cancer Patients ◽

Node Negative ◽

Node Negative Breast Cancer ◽

Disease Free

PURPOSE Formalin-fixed, paraffin-embedded tissues from axillary node-negative breast cancer patients were analyzed by flow cytometry to determine the prognostic significance of DNA ploidy and S-phase fraction (SPF). PATIENTS AND METHODS All patients were registered on a good-risk control arm of an intergroup clinical trial. They had small- to intermediate-sized (less than 3 cm), estrogen receptor (ER)-positive tumors and received no adjuvant therapy after modified radical mastectomy or total mastectomy with low axillary-node sampling. The median follow-up was 4.8 years. RESULTS Assessable ploidy results were obtained from 92% of the 298 specimens studied (51% diploid, 49% aneuploid), and SPFs were assessable for 83% of the tumors. SPFs for diploid tumors ranged from 0.7% to 11.9% (median, 3.6%), compared with a range of 1.2% to 26.7% (median, 7.6%) for aneuploid tumors (P less than .0001). No significant differences in disease-free or overall survival were observed between patients with diploid and aneuploid tumors. Using different SPF cutoffs by ploidy status (4.4% for diploid, 7.0% for aneuploid), patients with low SPFs had significantly longer disease-free survival rates than patients with high SPFs (P = .0008). The actuarial 5-year relapse rates were 15% and 32% for patients with low (n = 142) and high SPFs (n = 105), respectively. Similar relationships between SPF and clinical outcome were observed for patients with diploid tumors (P = .053) and for patients with aneuploid tumors (P = .0012). CONCLUSION S-phase fraction provides additional prognostic information for predicting disease-free survival for axillary node-negative breast cancer patients with small, ER-positive tumors.

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