SURGICAL-PROCEDURE CAN EXPLAIN VARYING INFLUENCE OF MENSTRUAL-CYCLE ON PROGNOSIS OF PREMENOPAUSAL BREAST-CANCER PATIENTS

The mechanism of how menstrual cycle influences prognosis of premenopa usal breast cancer patients is still unclear, In an analysis of 266 pr emenopausal patients we could confirm that patients who were operated on during the progestagenic phase (day 0-2 and 13-35) of the menstrual cycle showed an improved clinical outcome, However, if one-step surge ry (tumour excision and definitive surgery on 1 day) was performed pro gnosis did not correlate with menstrual cycle (p = 0.8, log rank test) , But, patients who underwent two-step surgery during the progestageni c phase showed a significantly longer disease-free survival (p < 0.001 ) and overall survival (p = 0.002) than patients in the oestrogenic ph ase, The effect was confined to node positive tumours (p = 0.003) and to hormone receptor positive tumours (p = 0.03), Our analysis suggests that if after diagnostic tumour excision intratumoural growth regulat ion is disturbed, and if tumour cells remain after excision (as in axi llary lymphnodes), the proliferative potential of these hormone-depend ent cells might be increased in an unopposed oestrogenic setting, thus faciliating metastatic spread.