DISEASE-FREE SURVIVAL OF NODE-POSITIVE BREAST-CANCER PATIENTS - IMPROVED PROGNOSTICATION BY CYTOMETRIC PARAMETERS

Feulgen stained cytologic samples from 225 node-positive breast cancer s were investigated by means of an image analysis system. From each tu mor sample, 100 cells were scanned and several DNA, morphometrical and textural parameters were evaluated. The meaning of the cytometric par ameters for prediction of distant metastases within five years was inv estigated by the stepwise Cox regression analysis. Most of the investi gated DNA- and morphometrical parameters, as well as one textural feat ure, showed a significant univariate correlation with the clinical cou rse. In the multivariate approach, the lymph node status (pN) was the strongest prognostic factor, followed by the histogram type, the tumor size (pT) and a textural parameter (heterochromatin area). By the lin ear combination of these selected variables a multivariate prognostic factor was calculated for each individual patient. Using this factor, the patients could be splitted into four groups according to their ris k for distant metastases. For this, the continuous range of the multiv ariate factor was subdivided so that about 35% of the patients were in the middle groups and about 15% of the patients in each of the border groups with highest and lowest factors, respectively. Thus a low risk group (lowest factors) of node-positive patients could be identified with a 5-year distant recurrence-rate of only 6.5%, as well as a group of patients with a considerably worse prognosis (highest factors) and a distant recurrence-rate of 67%. Therefore, DNA, morphometrical and textural parameters can provide powerful prognostic information in nod e-positive breast carcinomas. Using the multivariate combination of cl inical and relevant cytometrical parameters may allow a more appropria te selection of patients for adjuvant therapy.