SELECTING HIGH-RISK EARLY BREAST-CANCER PATIENTS - WHAT TO ADD TO THENUMBER OF METASTATIC NODES

High-risk early breast cancer patients are usually identified by the n umber of metastatic axillary nodes. To study whether other easily and inexpensively detectable morphological factors are able to detect high -risk patients, we performed a retrospective analysis of tumour size, and skin/fascia and nipple invasion. The data consisted of 941 node-po sitive cases registered between 1978 and 1991. Tumour size, and skin/f ascia and nipple invasion were closely associated with the number of m etastatic nodes (chi(2) test). The number of metastatic nodes, tumour size, skin/fascia and nipple invasion significantly affected disease f ree survival (DFS) and overall survival (OS) at univariate analysis. T hese results were confirmed by multivariate analysis with a model cont aining the number of metastatic nodes, tumour diameter categories, ski n/fascia invasion, nipple invasion and adjuvant therapy as covariates: all variables significantly and independently affected risk of relaps e and of death. All the variables studied were prognostic, within indi vidual nodal categories, for both DFS and OS. In conclusion, the numbe r of metastatic nodes is not the only prognostic tool with which to se lect high-risk patients for new intensive adjuvant programmes. Tumour size, and skin/fascia invasion or nipple invasion, taken singly or com bined, are valuable prognostic factors that can identify patients with few metastatic nodes and poor outcome. On the basis of our data, we b elieve that a reconsideration of the pT4 category within the pTNM clas sification is in order, that is, chest wall invasion should be substit uted by fascia invasion, and combined skin/fascia invasion could be a subcategory of each class defined by tumour size.