A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma.

Abstract

This study was undertaken to investigate the long-term survival and the probability of "cure" in a group of 644 patients treated by mastectomy for T1 breast carcinoma. After a median follow-up of 18.2 years, 23% were dead of recurrent breast carcinoma, 3% were alive with recurrent disease, and 74% had not experienced a recurrence. The probability of recurrence was directly related to the initial extent of the disease. Overall, 16% of recurrences and 25% of deaths due to disease occurred in the second decade of follow-up. The proportion of recurrences detected in the second decade was inversely related to the stage of the primary tumor at diagnosis. When stratified by tumor size, T1N0M0 patients with tumors 1.0 cm or less in diameter had a significantly better 20-year recurrence-free survival (86%) than did T1N0M0 patients with tumors 1.1 to 2.0 cm (69%). When observed and expected survival curves were compared by the method of Brinkley and Haybittle, it appeared that 80% of T1N0M0 patients with tumors 1 cm or less might be cured at 20 years, whereas for those in the 1.1- to 2-cm group, the proportion cured was indeterminate, but might be as high as 70%. A potentially cured group could not be identified among T1N1M0 patients, but an estimated 52% of these patients did not have a recurrence within the nearly 20-year follow-up period. These data are important when one considers the proper role of adjuvant therapy for stage I disease. Patients with tumors larger than 1 cm and those with axillary lymph node metastases may have an improved recurrence-free survival as a result of systemic adjuvant treatment, while women in the T1N0M0 group with an especially favorable recurrence-free survival, particularly those with tumors 1 cm in diameter or smaller, might be spared adjuvant therapy.

Long-term survival in node-positive breast cancer treated by locoregional therapy alone

“…This figure is in line with that found by Rosen et al (1989), who estimated that 52% of patients (Tables 2 and 3), none of the factors could identify a subset of patients with particularly favourable survival. Hence, adjuvant systemic therapy should probably be recommended to all patients with pN+ disease, because there is currently no reliable way to identify patients who might be cured without adjuvant therapy.…”

“…There are a few reported series in which a subset of patients with node-positive breast cancer has been found to survive longer than 20 years after the diagnosis, suggesting that node-positive breast cancer may sometimes be a curable disease (Adair et al, 1974;Fentiman et al, 1984;Rutqvist et al, 1985;Rosen et al, 1989; Lee et al, 1992;Nab et al, 1994). However, treatment given in these series has been variable, and the series may have included patients who received systemic treatments in addition to local therapy.…”

Prognostic relevance of urokinase plasminogen activator detection in micrometastatic cells in the bone marrow of patients with primary breast cancer

“…Although the axillary lymph node status is considered to be the best prognostic factor with regard to disease-free survival and overall survival, it reflects only indirectly the process of haematogenic metastasis. Therefore, 30% of patients with node-negative breast cancer at primary surgery will relapse within 10 years (Rosen et al, 1989). Tumour cell detection (TCD) in bone marrow can offer an alternative to the prognostic value of the nodal state.…”

Expression of E-Cadherin in breast carcinomas and its association with other biological markers — a prospective study

“…[3][4][5] Recent emphasis is on identifying markers related to tumor metastasis, which is the major cause of morbidity and Original Article mortality in these patients'. 6 Certain specific cell-to-cell adhesion molecules have been found to be responsible for embryonic development. One such molecule is a family of 'Cadherins'.…”