Prediction of node-negative breast cancer outcome by histologic grading and S-phase analysis by flow cytometry - An Eastern Cooperative Oncology Group study (2192)
Prediction of node-negative breast cancer outcome by histologic grading and S-phase analysis by flow cytometry - An Eastern Cooperative Oncology Group study (2192)
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DOI：
10.1097/00000421-200102000-00002
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发表时间：
2001-02-01
影响因子：
2.6
通讯作者：
Wood, WC
中科院分区：
文献类型：
--
作者：
Page, DL;Gray, R;Wood, WC
浸润性乳腺癌的组织学评估和报告有效地使用了诺丁汉联合组织学分级(NCHG)。这种预测浸润性乳腺癌预后的方法还没有在多中心合作试验中进行测试。对参加东部合作肿瘤组试验的部分乳腺癌病例的组织学切片进行分级。两位病理学家评估了从分化定义的NCHG病例。有丝分裂指数和核分级。研究人群由来自低风险和高风险阶层的单独样本组成，其中低风险是雌激素受体阳性且肿瘤大小小于3 cm，高风险是雌激素受体阴性或肿瘤大小大于或等于3 cm。符合率总体上是好的，80%的病例在有丝分裂计数方面相同，76%的病例在综合分级上相同。在三个类别中，从最低到最高没有不一致的案例。中位随访期为11.6年，但在生存分析中，这一数字被截断为5年。两位病理学家评估的有丝分裂指数和联合分级与存活率显著相关。联合组织学分级高的患者对环磷酰胺/甲氨蝶呤/5-氟尿嘧啶(CMF)的疗效有预测作用，在接受治疗的高度恶性患者中，5年生存率比未治疗患者差30%。总体而言，很明显，病理学家可以在联合组织学分级的分配上有密切的一致，在单变量和多变量分析中对复发时间和生存的预测具有非常显著的预测意义和边缘意义。因此，这些试验中使用的分层如所希望的那样具有高度的预后意义，为这些相对较大的肿瘤的组织学分级留下了一个作用，比本系列中的S时相分析更有效。在CMF和观察组之间随机分组的高危患者中，有一种建议是，高联合分级组可以预测治疗效果。我们的结论是，具有明确标准的综合组织学分级可以由经验丰富的病理学家使用现成的标准可靠地指定，并且当以技术上理想的方式进行时，该测量可以用于预测和预测治疗反应。
Histologic evaluation and reporting of invasive breast cancer has effectively used Nottingham combined histologic grade (NCHG). This approach to predict outcome in invasive breast cancer has not been tested in multicenter cooperative trials. Histologic slides from selected breast cancer cases entered on node-negative Eastern Cooperative Oncology Group trials were assigned grades. Two pathologists evaluated cases for NCHG defined from differentiation. mitotic index, and nuclear grade. The study population consisted of separate samples from low- and high-risk strata, where low risk was estrogen receptor positive with a tumor size of less than 3 cm and high risk was estrogen receptor negative or tumor size greater than or equal to 3 cm. The rate of agreement was generally good, with 80% of cases classified the same for mitotic count and 76% of the cases classified the same for combined grade. There were no cases disagreeing from the lowest to the highest of the three categories. The median follow-up is 11.6 years, but for analysis of survival, this was truncated at 5 years. Mitotic index and combined grade as assessed by both pathologists showed significant associations with survival. High combined histologic grade was predictive for response to cyclophosphamide/methotrexate/5-fluorouracil (CMF) with survival differences at 5 years of 30% in the treated high-grade patients over the un-treated patients. Overall, it is clear that pathologists can have close agreement in assignment of combined histologic grades, with highly significant prediction in univariate and borderline significance in multivariate analysis in prognostication of time to recurrence as well as survival. Thus, stratification used in these trials was highly prognostic as hoped, leaving a role for histologic grading in these relatively large tumors, more powerful than S-phase analysis in this series. In the subgroups of high-risk patients randomized between CMF and observation, there was a suggestion that the high-combined-grade group was predictive of treatment efficacy. We conclude that a combined histologic grade with defined criteria may be reliably assigned by practiced pathologists using readily available criteria, and that the measure may be of use in prognostication and prediction of therapeutic responsiveness when done in a technically ideal fashion.