NUCLEAR GRADE AND DNA-PLOIDY IN STAGE-IV BREAST-CANCER WITH ONLY VISCERAL METASTASES AT INITIAL DIAGNOSIS

Aims and background: The presence of early metastases to distant sites in breast cancer patients is an infrequent event whose mechanisms are still not clear. The aim of this study this was to evaluate the biolo gic and clinical role of DNA ploidy and cell nuclear grade of primary tumors in the metastatic process of a series of stage IV previously un treated breast cancer patients with only visceral metastases. Methods: DNA flow cytometry analysis on paraffin-embedded material and cell nu clear grading of primary tumors was Performed on a series of 50 breast cancer patients with only visceral metastases at the time of initial diagnosis. Results: Aneuploidy was found in 28/46 (61%) of evaluable c ases and was independent of site of involvement, clinical response, ti me to progression and overall survival of patients. Of the 46 cases ev aluable for nuclear grade, 5 (11%), 16 (35%) and 25 (54%) were classif ied as G(1) (well-differentiated G(2) and G(3), respectively. Nuclear grade also was unrelated to response to therapy and overall survival, whereas time to progression was significantly longer in G(1-2) than G( 3) tumors with the logrank test (P<0.03) and multivariate analysis. Co nclusions: Our results seem to stress the difficulty to individualize different prognostic subsets from a series of breast cancer patients w ith only visceral metastases at initial diagnosis according to DNA flo w cytometry and nuclear grade.