PRIMARY PROGNOSTIC FACTORS IN INVASIVE BREAST-CANCER WITH SPECIAL REFERENCE TO DUCTAL CARCINOMA AND HISTOLOGIC MALIGNANCY GRADE

Background. In a study of 2290 cases of invasive breast cancer in Malm o, the prognostic value of histologic typing and axillary nodal status was examined. Two periods were studied: Period 1, 1961-1970, and Peri od 2, 1981-1988. Methods. All primarily unilateral invasive breast can cers were included in the study and classified according to the histol ogic classification proposed by Linell et al. and Linell and Ljungberg (1,2) (the Linell-Ljungberg classification), which includes a histolog ic grading of ductal carcinoma based on content of tubular structures. From Period 1, the tumors were reclassified. In Period 2, the Linell- Ljungberg classification was used as a clinical routine. Median follow -up in Period 1 was 23 years, and in Period 2, 5 years. Survival was c alculated in relation to histologic type and axillary nodal status. Re sults. The Linell-Ljungberg classification divides invasive ductal car cinoma (IDC) into two groups of approximately equal size: IDC of comed o type, 40% of total; and IDC of tubuloductal type, 30% of total. Ther e was a significantly better survival rate in the tubuloductal group t han in the comedo group. In a multivariate analysis, this difference w as shown to be independent of axillary nodal status and tumor size. By combining histologic classification with axillary nodal status, one g roup of patients could be identified containing 90% of patients dying from breast cancer within 5 years of diagnosis and another group with less than 10% risk of dying from breast cancer within 5 years. Conclus ions. Valuable prognostic information can be obtained in a clinical se tting from routinely obtained primary prognostic factors in breast can cer: pTNM stage, histologic type, and histologic malignancy grade. Thi s information should be considered the baseline in the clinical evalua tion of other more elaborate prognostic factors.