The prognostic role of tumor size in early breast cancer in the era of molecular biology

Abstract

BackgroundThe prognosis of early breast cancer (EBC) depends on patient and tumor characteristics. The association between tumor size, the largest diameter in TNM staging, and prognosis is well recognized. According to TNM, tumors classified as T2, could have very different volumes; e.g. a tumor of 2.1 cm has a volume of 4500 mm3, while a tumor of 4.9 cm has a volume of 60.000 mm3 even belonging to the same class. The aim of the study is to establish if the prognostic role of tumor size, expressed as diameter and volume, has been overshadowed by other factors.MethodsThe primary objective is to evaluate the association between tumor dimensions and overall survival (OS) / disease free survival (DFS), in our institution from January 1st 2005 to September 30th 2013 in a surgical T1-T2 population. Volume was evaluated with the measurement of three half-diameters of the tumor (a, b and c), and calculated using the following formula: 4/3π x a x b x c.Results341 patients with T1-T2 EBC were included. 86.5% were treated with conservative surgery. 85.1% had a Luminal subtype, 9.1% were Triple negative and 7.4% were HER2 positive. Median volume was 942 mm3 (range 0.52–31.651.2). 44 patients (12.9%) relapsed and 23 patients died. With a median follow-up of 6.5 years, the univariate analysis for DFS showed an association between age, tumor size, volume, histological grading and molecular subtype. The multivariate analysis confirmed the statistically significant association only for molecular subtype (p 0.005), with a worse prognosis for Triple negative and HER2 positive subtypes compared with Luminal (HR: 2.65; 95%CI: 1.34–5.22). Likewise for OS, an association was shown by the multivariate analysis solely for molecular subtype (HER2 and Triple negative vs. Luminal. HR: 2.83; 95% CI:1.46–5.49; p 0.002).ConclusionsIn our study, the only parameter that strongly influences survival is molecular subtype. These findings encourage clinicians to choose adjuvant treatment not based on dimensional criteria but on biological features.

Impact of HER2 receptor status on axillary nodal burden in patients with non-luminal A invasive ductal breast carcinoma

“…Our results, showing that both the number of positive ALNs and the presence of LVI have a negative impact on the survival rates, are in line with previously published data [32][33][34][35][36] . In concordance with former observations, BC molecular subtype also affected survival 12,24,31 .…”

“…The tumor size is established as an independent predictor of survival in BC patients 23 . However, its prognostic role has been denied in some papers 31 . In this study, tumor size, as well as higher histologic grades, were negatively correlated with the survival rates 8,13,14,18 .…”

“…The data concerning the impact of age on the prognosis in BC patients are conflicting 31,37 . We observed no impact of age (≤ 50/> 50 years) on the survival rates.…”

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

“…A high tumor/breast ratio (relatively large tumor and/ or small size breast) decreases BCS rate in patients with early stage breast cancer. Neo-adjuvant chemotherapy (NAC) to reduce tumor size, mastectomy with implant or simple mastectomy are the commonly selected options in these patients [29,30]. However, NAC has a limited effect on primary tumor and axilla especially in patients with luminal A molecular subtype [31].…”

Down Regulation of KAI1/CD82 in Lymph Node Positive and Advanced T-Stage Group in Breast Cancer Patients

“…Similarly, a study by Yang et al, (2000) demonstrated significantly high expression levels of KAI-1 in normal breast tissues and benign breast tumours than in breast cancer. Breast cancer is typically categorised in stages based on American Joint Committee on Cancer (AJCC) TNM classification, (Tumor Nodes Metastasis) which recommends the tumor size (T), presence of metastatic lymph nodes (N) and metastasis (M) are the fundamental determinants of staging (Kasangian et al, 2017). Axillary lymph node status is one of the most vital prognostic factors and lymph node involvement is associated with high risk of distant metastasis, regional recurrence, and poor survival in breast carcinoma, where as patients with lymph node negative have favourable prognosis (Howland et al, 2013;Dings et al, 2013).…”