PROSPECTIVE EVALUATION OF PROGNOSTIC FACTORS IN OPERABLE BREAST-CANCER

In 215 patients with operable breast cancer (T1-T3, N0-1, MO) and no o ther or previous cancer, presenting to a single breast unit, sufficien t tumour was available for the prospective determination of four putat ive biochemical markers of prognosis: oestrogen receptor (ER) activity , cathepsin D (cath D), epidermal growth factor receptor (EGFR) activi ty and cyclic AMP-binding proteins (c-AMP-b). There were significant i nter-relationships between ER and EGFR (r = -0.26), c-AMP-b and cath D (r = +0.32) and ER and c-AMP-b (r = +0.14). After follow-up (median 3 6.2 months), a total of 55 recurrences (18 locoregional only) and 35 d eaths were recorded. By univariate analysis, up to 10 of 18 biochemica l, clinical and histopathological variables of potential prognostic va lue were significantly related to disease-free interval or death, but by multivariate analysis only oestrogen receptor concentration and nod e status contributed significantly to risk of both distant recurrence/ death; in addition, tumour size made a small contribution to the risk for a distant recurrence only. Only two parameters, tumour grade and E R concentration, were significantly related to risk of locoregional re currence by univariate analysis, but by multivariate analysis, only tu mour grade was important. It is concluded that tumour ER concentration , axillary nodal status and tumour grade remain as the most important prognostic factors in the early years after presentation of operable b reast cancer, with a minor influence of tumour size. At this time, the prognostic significance of quantitative measurements of ER concentrat ion, carefully controlled for the quality of both assay and tumour spe cimen, is probably greater than is generally appreciated. We have yet to identify other factors, which add significantly to the short-term p rognostic value of these key features.