Prognostic factors for breast carcinoma

PROGNOSTIC FACTORS FOR BREAST CARCINOMA

• In situ carcinoma – Patients with in situ carcinoma has better prognosis than invasive carcinoma

• Distant metastasis – patients with distant metastasis have poor prognosis than the patients with tumor confined to the organ

• Lymphnode metastasis-

  • Axillary lymph node status is an important prognostic factor.

  • Involvement of number of lymph nodes influences the survival rate of patient (10 years survival rate is 35% to 40% in patients with one – three positive nodes and 10 -15% with more than 10 positive nodes

• Tumor size –

  • Tumor size is related to the risk of lymph node metastasis.

  • As the size increases the risk of metastasis increases. But the size is not important risk factor for HER2 – positive and ER negative carcinomas as they metastasize even when they are small.

• Locally advanced disease – Carcinomas involving skin or skeletal muscle have poor prognosis

• Inflammatory carcinoma –

  • Breast cancers presenting as breast erythema and skin thickening have poor prognosis.

  • Edematous skin is tethered to the breast by cooper ligaments and mimics the surface of an orange peel (Peau d’orange). These clinical signs are caused by dermal lymphatics filled with metastatic carcinoma that blocks lymphatic drainage.

  • Inflammatory carcinomas are ER negative and 40%to 50% of cases over express HER2.

• Lymphovascular invasion – tumors with lymphatic and vascular invasion has poor prognosis

• Special histologic type –

  • Tubular, mucinous, lobular, papillary, adenoid cystic have better prognosis than invasive ductal carcinoma NOS.

  • Metaplastic and micropapillary carcinoma have poor prognosis

• Histologic grade – Nottingham histologic grade depending upon nuclear grade, tubule formation and mitotic rate is an important prognostic factor. Depending upon these factors 3 histologic grades have been described. Grade 1 is well differentiated and grade 3 is poorly differentiated.

  • Tubule formation –

    • 1 point – >75% of tumor

    • 2 points- 10 – 75% of tumor

    • 3 points – <10% of tumor

  • Mitotic figures

• Nuclear pleomorphism

  • 1 point – minimal nuclear variation in size and shape

  • 2points – moderate nuclear variation in size and shape

  • 3 points – marked variation in size and shape

• Scoring

  • 3 – 5 points – well differentiated (grade I)

  • 6 – 7 points – Moderately differentiated (grade II)

  • 8 – 9 points – poorly differentiated (grade III)

• Proliferative rate – Carcinomas with high proliferation have poor prognosis

• Estrogen and Progesterone receptors –

  • 80% of tumors are ER and PR positive.

  • 40% of them show only ER or PR positivity.

  • Strongly ER positive cancers are less likely to respond to chemotherapy but respond to hormonal therapy.

  • If tumors fail to express ER or PR then less than 10% of them respond to hormonal therapy  but respond to chemotherapy

• HER 2 – Overexpression of HER2 is associated with poor prognosis

• Stage of tumor – Tumor in the stage I has better prognosis than the in stage IV.

References

1. Vinay kumar, Abul K.Abbas, Nelson Fausto, Jon C. Aster. The Breast. In: Robbins and Cotran Pathologic basis of disease. 8th edition.