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Abstract

There is an increasing recognition that breast cancer can be heterogeneous and composed of a variety of subgroups with different prognosis. Identification of favorable and unfavorable groups helps clinicians to individualize and tailor the treatment for each patient. In order to complete risk stratification, patient and tumor characteristics were being used as prognostic and predictive factors. By definition, the prognostic factor is a measurable variable that correlates with the natural history of the disease. In contrast, a predictive factor is one that is associated with response to a given therapy. Some factors, such as estrogen receptor (ER)/progesterone receptor (PR) status and human epidermal growth factor receptor-2 (Her-2)/neu gene amplification and/or overexpression, are both prognostic and predictive [1]. This chapter focuses on the widely used major prognostic and predictive factors related to patient and tumor characteristics for breast cancer-specific outcomes.

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References

  1. http://www.cap.org/apps/docs/newspath/0709/prognostic_and_predictive_factors_in_breast_cancer.pdf.Accessed 12/11/2011.

  2. Fitzgibbons PL, Page DL, Weaver D, et al. Prognostic factors in breast cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med. 2000;124:966–78.

    PubMed  CAS  Google Scholar 

  3. Quiet CA, Ferguson DJ, Weichselbaum RR, Hellman S. Natural history of node-negative breast cancer: a study of 826 patients with long-term follow-up. J Clin Oncol. 1995;13:1144–51.

    PubMed  CAS  Google Scholar 

  4. Goldhirsch A, Wood WC, Gelber RD, et al. 10th St. Gallen conference. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer. Ann Oncol. 2007;18:1133–44.

    Article  PubMed  CAS  Google Scholar 

  5. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer. 1989;63:181–7.

    Article  PubMed  CAS  Google Scholar 

  6. Verschraegen C, Vinh-Hung V, Cserni G, et al. Modeling the effect of tumor size in early breast cancer. Ann Surg. 2005;241:309–18.

    Article  PubMed  Google Scholar 

  7. Freedman GM, Hanlon AL, Fowble BL, et al. Recursive partitioning identifies patients at high and low risk for ipsilateral tumor recurrence after breast-conserving surgery and radiation. J Clin Oncol. 2002;20:4015–21.

    Article  PubMed  CAS  Google Scholar 

  8. Cheng JC, Chen CM, Liu MC, et al. Locoregional failure of postmastectomy patients with 1–3 positive axillary lymph nodes without adjuvant radiotherapy. Int J Radiat Oncol Biol Phys. 2002;52:980–8.

    Article  PubMed  Google Scholar 

  9. Katz A, Strom EA, Buchholz TA, et al. The influence of pathologic tumor characteristics on locoregional recurrence rates following mastectomy. Int J Radiat Oncol Biol Phys. 2001;50:735–42.

    Article  PubMed  CAS  Google Scholar 

  10. Katz A, Strom EA, Buchholz TA, et al. Locoregional recurrence patterns after mastectomy and doxorubicin-based chemotherapy: implications for postoperative irradiation. J Clin Oncol. 2000;18:2817–27.

    PubMed  CAS  Google Scholar 

  11. Halperin EC, Perez CA, Brady LW. Principles and practice of radiation oncology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 1176–278.

    Google Scholar 

  12. Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, editors. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.

    Google Scholar 

  13. Fisher B, Bauer M, Margolese R, et al. Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med. 1985;312:665–73.

    Article  PubMed  CAS  Google Scholar 

  14. Fisher B, Anderson S. Conservative surgery for the management of invasive and noninvasive carcinoma of the breast: NSABP trials: National Surgical Adjuvant Breast and Bowel Project. World J Surg. 1994;18:63–9.

    Article  PubMed  CAS  Google Scholar 

  15. Atahan IL, Yildiz F, Ozyigit G, et al. Percent positive axillary lymph node metastasis predicts survival in patients with non-metastatic breast cancer. Acta Oncol. 2008;47:232–8.

    Article  Google Scholar 

  16. Gobardhan PD, Elias SG, Madsen EV, et al. Prognostic value of lymph node micrometastases in breast cancer: a multicenter cohort study. Ann Surg Oncol. 2011;18:1657–64.

    Article  PubMed  Google Scholar 

  17. Tjan-Heijnen VC, Pepels MJ, de Boer M. Prognostic impact of isolated tumor cells and micrometastases in axillary lymph nodes of breast cancer patients. Breast Dis. 2010;31:107–13.

    PubMed  Google Scholar 

  18. Kim MJ, Gong G, Joo HJ, et al. Immunohistochemical and clinicopathologic characteristics of invasive ductal carcinoma of breast with micropapillary carcinoma component. Arch Pathol Lab Med. 2005;129:1277–82.

    PubMed  Google Scholar 

  19. Fisher ER, Gregorio RM, Fisher B, et al. The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4). Cancer. 1975;36:1–85.

    Article  PubMed  CAS  Google Scholar 

  20. Sullivan T, Raad RA, Goldberg S, et al. Tubular carcinoma of the breast: a retrospective analysis and review of the literature. Breast Cancer Res Treat. 2005;93:199–205.

    Article  PubMed  Google Scholar 

  21. Sastre-Garau X, Jouve M, Asselain B, et al. Infiltrating lobular carcinoma of the breast. Clinicopathologic analysis of 975 cases with reference to data on conservative therapy and metastatic patterns. Cancer. 1996;77:113–20.

    Article  PubMed  CAS  Google Scholar 

  22. Santiago RJ, Harris EE, Qin L, et al. Similar long-term results of breast-conservation treatment for Stage I and II invasive lobular carcinoma compared with invasive ductal carcinoma of the breast: The University of Pennsylvania experience. Cancer. 2005;103:2447–54.

    Article  PubMed  Google Scholar 

  23. Elston CW, Ellis IO. Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. Histopathology. 1991;19:403–10.

    Article  PubMed  CAS  Google Scholar 

  24. Warwick J, Tabàr L, Vitak B, Duffy SW. Time-dependent effects on survival in breast carcinoma: results of 20 years of follow-up from the Swedish Two-County Study. Cancer. 2004;100:1331–6.

    Article  PubMed  Google Scholar 

  25. Rosen PP, Saigo PE, Braun DW, et al. Predictors of recurrence in stage I (T1N0M0) breast carcinoma. Ann Surg. 1981;193:15–25.

    Article  PubMed  CAS  Google Scholar 

  26. Rosen PP. Tumor emboli in intramammary lymphatics in breast carcinoma: pathologic criteria for diagnosis and clinical significance. Pathol Annu. 1983;18:215–32.

    PubMed  Google Scholar 

  27. Truong PT, Yong CM, Abnousi F, et al. Lymphovascular invasion is associated with reduced locoregional control and survival in women with node-negative breast cancer treated with mastectomy and systemic therapy. J Am Coll Surg. 2005;200:912–21.

    Article  PubMed  Google Scholar 

  28. Lee AH, Pinder SE, Macmillan RD, et al. Prognostic value of lymphovascular invasion in women with lymph node negative invasive breast carcinoma. Eur J Cancer. 2006;42:357–62.

    Article  PubMed  CAS  Google Scholar 

  29. Budrukkar AN, Sarin R, Chinoy RF, et al. Prognostic factors in node negative premenopausal women treated with breast conserving therapy without adjuvant systemic therapy. Breast. 2008;17:263–9.

    Article  PubMed  Google Scholar 

  30. Harris JR, Connolly JL, Schnitt SJ, et al. The use of pathologic features in selecting the extent of surgical resection necessary for breast cancer patients treated by primary radiation therapy. Ann Surg. 1985;201:164–9.

    Article  PubMed  CAS  Google Scholar 

  31. Kurtz JM, Jacquemier J, Amalric R, et al. Risk factors for breast recurrence in premenopausal and postmenopausal patients with ductal cancers treated by conservation therapy. Cancer. 1990;65:1867–78.

    Article  PubMed  CAS  Google Scholar 

  32. Gage I, Schnitt SJ, Nixon AJ, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer. 1996;78:1921–8.

    Article  PubMed  CAS  Google Scholar 

  33. Vicini F, Jones P, Rivers A, et al. Differences in disease presentation, management techniques, treatment outcome, and toxicities in African-American women with early stage breast cancer treated with breast-conserving therapy. Cancer. 2010;116:3485–92.

    Article  PubMed  Google Scholar 

  34. Newman LA, Theriault R, Clendinnin N, et al. Treatment choices and response rates in African-American women with breast carcinoma. Cancer. 2003;97:246–52.

    Article  PubMed  Google Scholar 

  35. Simon MS, Severson RK. Racial differences in survival of female breast cancer in the Detroit metropolitan area. Cancer. 1996;77:308–14.

    Article  PubMed  CAS  Google Scholar 

  36. Pierce L, Fowble B, Solin LJ, et al. Conservative surgery and radiation therapy in black women with early stage breast cancer. Patterns of failure and analysis of outcome. Cancer. 1992;69:2831–41.

    Article  PubMed  CAS  Google Scholar 

  37. Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol. 1994;12:888–94.

    PubMed  CAS  Google Scholar 

  38. Fowble BL, Schultz DJ, Overmoyer B, et al. The influence of young age on outcome in early stage breast cancer. Int J Radiat Oncol Biol Phys. 1994;30:23–33.

    Article  PubMed  CAS  Google Scholar 

  39. Mirza NQ, Vlastos G, Meric F, et al. Predictors of locoregional recurrence among patients with early-stage breast cancer treated with breast-conserving therapy. Ann Surg Oncol. 2002;9:256–65.

    Article  PubMed  Google Scholar 

  40. Kroman N, Jensen MB, Wohlfahrt J, et al. Factors influencing the effect of age on prognosis in breast cancer: population based study. BMJ. 2000;320:474–8.

    Article  PubMed  CAS  Google Scholar 

  41. Colleoni M, Rotmensz N, Robertson C, et al. Very young women (<35 years) with operable breast cancer: features of disease at presentation. Ann Oncol. 2002;13:273–9.

    Article  PubMed  CAS  Google Scholar 

  42. Anders C, Hsu D, Broadwater G, et al. Young age at diagnosis correlates with worse prognosis and defines a subset of breast cancers with shared patterns of gene expression. J Clin Oncol. 2008;26:3324–30.

    Article  PubMed  Google Scholar 

  43. Margenthaler J. Younger women diagnosed with early-stage breast cancer more likely to die than older women. American College of Surgeons Clinical Congress; October 12–16, 2008. San Francisco, CA; 2008.

    Google Scholar 

  44. Arriagada R, Le MG, Dunant A, et al. Twenty-five years of follow-up in patients with operable breast carcinoma: correlation between clinicopathologic factors and the risk of death in each 5-year period. Cancer. 2006;106:743–50.

    Article  PubMed  Google Scholar 

  45. Fisher ER, Sass R, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity. Cancer. 1986;57:1717–24.

    Article  PubMed  CAS  Google Scholar 

  46. Solin LJ, Fowble BL, Schultz DJ, et al. The significance of the pathology margins of the tumor excision on the outcome of patients treated with definitive irradiation for early stage breast cancer. Int J Radiat Oncol Biol Phys. 1991;21:279–87.

    Article  PubMed  CAS  Google Scholar 

  47. Schmidt-Ullrich RK, Wazer DE, DiPetrillo T, et al. Breast conservation therapy for early stage breast carcinoma with outstanding 10-year locoregional control rates: a case for aggressive therapy to the tumor bearing quadrant. Int J Radiat Oncol Biol Phys. 1993;27:545–52.

    Article  PubMed  CAS  Google Scholar 

  48. Ryoo MC, Kagan AR, Wollin M, et al. Prognostic factors for recurrence and cosmesis in 393 patients after radiation therapy for early mammary carcinoma. Radiology. 1989;172:555–9.

    PubMed  CAS  Google Scholar 

  49. Stuart-Harris R, Caldas C, Pinder SE, Pharoah P. Proliferation markers and survival in early breast cancer: a systematic review and meta-analysis of 85 studies in 32,825 patients. Breast. 2008;17:323–34.

    Article  PubMed  CAS  Google Scholar 

  50. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011 Panel members. Ann Oncol. 2011;22:1736–47.

    Article  PubMed  CAS  Google Scholar 

  51. Haffty BG, Goyal S. Molecular subtyping of early-stage breast cancer: implications for radiation therapy. Int J Radiat Oncol Biol Phys. 2010;77:1293–5.

    Article  PubMed  Google Scholar 

  52. Albert JM, Gonzalez-Angulo AM, Guray M, et al. Estrogen/progesterone receptor negativity and HER2 positivity predict locoregional recurrence in patients with T1a, bN0 breast cancer. Int J Radiat Oncol Biol Phys. 2010;77:1296–302.

    Article  PubMed  CAS  Google Scholar 

  53. Nguyen PL, Taghian AG, Katz MS, et al. Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol. 2008;26:2373–8.

    Article  PubMed  Google Scholar 

  54. Seynaeve C, Verhoog LC, van de Bosch LM, et al. Ipsilateral breast tumour recurrence in hereditary breast cancer following breast-conserving therapy. Eur J Cancer. 2004;40:1150–8.

    Article  PubMed  CAS  Google Scholar 

  55. Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet. 2002;359:1471–7.

    Article  PubMed  Google Scholar 

  56. Pierce LJ, Levin AM, Rebbeck TR, et al. Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol. 2006;24:2437–43.

    Article  PubMed  Google Scholar 

  57. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet. 2005;365:1687–717.

    Article  Google Scholar 

  58. Coombes RC, Kilburn LS, Snowdon CF, et al. Intergroup Exemestane Study. (Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet. 2007;369:559–70.

    Google Scholar 

  59. Kaufmann M, Jonat W, Hilfrich J, et al. Improved overall survival in postmenopausal women with early breast cancer after anastrozole initiated after treatment with tamoxifen compared with continued tamoxifen: the ARNO 95 Study. J Clin Oncol. 2007;25:2664–70.

    Article  PubMed  CAS  Google Scholar 

  60. Goss PE, Ingle JN, Martino S, et al. Randomized trial of letrozole following tamoxifen as extended adjuvant therapy in receptor-positive breast cancer: updated findings from NCIC CTG MA.17. J Natl Cancer Inst. 2005;97:1262–71.

    Article  PubMed  CAS  Google Scholar 

  61. Gianni L, Dafni U, Gelber RD, et al. Treatment with trastuzumab for 1 year after adjuvant chemotherapy in patients with HER2-positive early breast cancer: a 4-year follow-up of a randomised controlled trial. Lancet Oncol. 2011;12:236–44.

    Article  PubMed  CAS  Google Scholar 

  62. Paik S, Bryant J, Tan-Chiu E, et al. HER2 and choice of adjuvant chemotherapy for invasive breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-15. J Natl Cancer Inst. 2000;92:1991–8.

    Article  PubMed  CAS  Google Scholar 

  63. Krijgsman O, Roepman P, Zwart W, et al. A diagnostic gene profile for molecular subtyping of breast cancer associated with treatment response. Breast Cancer Res Treat. 2011. doi:10.1007/s10549-011-1683-z.

  64. Goldhirsch A, Glick JH, Gelber RD, Senn HJ. Meeting highlights: International Consensus Panel on the Treatment of Primary Breast Cancer. J Natl Cancer Inst. 1998;90:1601–88.

    Article  PubMed  CAS  Google Scholar 

  65. http://www.adjuvantonline.com/index.jsp. Accessed 12/11/2011.

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Correspondence to Senem Demirci Alanyalı .

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Alanyalı, S.D. (2013). Prognostic and Predictive Factors. In: Haydaroglu, A., Ozyigit, G. (eds) Principles and Practice of Modern Radiotherapy Techniques in Breast Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5116-7_4

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  • DOI: https://doi.org/10.1007/978-1-4614-5116-7_4

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