Prognostic factors in resectable breast cancer

The traditional unfavorable clinicopathologic features in operable breast cancer are large tumor size, number of axillary node metastases, poorly differentiated grade, presence of lymphatic tumor emboli near to the primary malignancy, blood vessel invasion, tumor necrosis, intense lymphoplasmocytic reaction around the tumor and perimenopausal status. Current multidisciplinary approach is still based on two major clinico-pathologic findings such as tumor size and number of infiltrated axillary nodes. Only in recent years the presence or absence of estrogen receptors was taken into consideration to administer adjuvant tamoxifen or adjuvant chemotherapy, respectively. Since the fundamental prognostic indicators in breast cancer are the total tumor cell number and its inherent biological aggressiveness, it is important to assess the clinical role of the proposed new determinants as a guide to prognosis in series of consecutive patients staged and managed according to uniform treatment programs. Properties such as hormone receptor status, ploidy and tumor cell kinetics (3H-TdR labeling index and percent of S-phase cell) as well as oncogenes should be evaluated also as expression of tumor cell burden and/or indicators of clinical aggressiveness. Recent results from retrospective case series strongly suggest that tumor cell proliferative activity, in particular labelling index, is a prognostic factor independent of axillary nodes, tumor size, and receptor status for the relapse-free survival of node-positive and node-negative tumors. This new prognostic factor should be taken into consideration in the selection of candidates for adjuvant chemotherapy.