PREDICTORS OF RECURRENCE FOR PATIENTS WITH SMALL (ONE CENTIMETER OR LESS) LOCALIZED BREAST-CANCER (T1A,B NO MO)

Background. The frequency of small (less than or equal to 1 cm) axilla ry lymph node negative invasive breast cancers (T1a,b NO MO) is increa sing because of wider implementation of breast cancer screening. Ident ification of prognostic factors for these patients has been based larg ely on retrospective pathology review. The authors analyzed histologic factors recorded in the original pathology reports to determine predi ctors of recurrence for patients with T1a,b NO MO breast cancer. Metho ds. Two hundred eighteen patients were studied. Potential prognostic f actors including measured millimeter tumor size in three dimensions, h istologic grade, nuclear grade, and presence or absence of lymphatic v essel invasion were documented prospectively in routine surgical patho logy reports of a large community (nonuniversity based) hospital. Foll ow-up was performed annually by the tumor registry. Results. With a me dian follow-up of 6.9 years (range, 3-15.8 years), overall recurrence free survival was 93%. Poor nuclear grade (hazard ratio, 5.8; 95% conf idence interval, 1.70-19.82; P = 0.004) and lymphatic vessel invasion (hazard ratio, 4.6; 95% confidence interval, 1.34-15.61; P = 0.01) wer e independent predictors of recurrence. Only 10% of patients had cance rs with both poor nuclear grade and lymphatic vessel invasion and thei r 67% 7-year recurrence free survival (RFS) rate was significantly low er than the 92% RFS rate observed for patients with one of these two f actors (P = 0.007) and the 99% RFS for patients with neither poor risk factor (P = 0.0001). Conclusions. The combination of poor nuclear gra de and lymphatic vessel invasion identifies a very small subset (10%) of patients with T1a,b NO MO breast cancer with a significant relapse risk that warrants consideration of adjuvant systemic therapy. However , the majority of patients with T1a,b NO MO breast cancer have an exce ptionally good prognosis.