PROGNOSTIC-SIGNIFICANCE OF NECROSIS, ELASTOSIS, FIBROSIS AND INFLAMMATORY CELL REACTION IN OPERABLE BREAST-CANCER

We analyzed retrospectively the relationships and the prognostic signi ficance of four anatomopathological features (elastosis, fibrosis, nec rosis, inflammatory cell reaction) of the primary tumor in a series of 1,457 cases of infiltrating ductal carcinoma observed at our institut ion from January 1978 to December 1991. Necrosis, elastosis, fibrosis and inflammatory cell reaction were strongly associated among themselv es (all p < 0.0001), the only exception being necrosis and elastosis. Necrosis was significantly related to tumor size (odds ratio [OR] = 5. 40, p < 0.0001) and tumor grade (OR = 2.22, p < 0.0001). Univariate an alysis showed that the presence of necrosis and cell reaction were sig nificantly related to worse survival (p < 0.0001 and p = 0.03, respect ively). Multivariate analysis, including the four variables plus nodal status, tumor size, grading, adjuvant therapy, age and first order in teractions, revealed that greater tumor size (p < 0.0001), positive no dal status (p < 0.0001), higher histologic grade (p < 0.0001) and pres ence of inflammatory cell reaction (p = 0.0007) independently worsened survival. On the other hand, adjuvant therapy had a significant indep endent role in preventing deaths (p = 0.03). The only first-order inte raction retained in the model was that between grading and cell reacti on (p = 0.002). Cell reaction had a different prognostic behaviour in the groups G1-G2 and G3. in the former group, survival was worse (p = 0.0001) when the inflammatory cell reaction was present. In conclusion , we demonstrate that cell reaction is an independent prognostic facto r in the G1-G2 subgroup of patients, and propose a hypothesis as to th e role of cell reaction in primary breast cancer.