Breast Cancer - Arab Medical Association Against Cancer

Prognostic Factors 215factor. For these reasons, multivariate statistical analysis only allows one to determineindependent prognostic factors. The relative value of the new biological parameters had tobe compared to the well defined prognostic factors.The prognostic value of factors determined in a series of patients receiving no adjuvanttherapy may be modified when hormonal treatment or chemotherapy are given, if this factoris predictive of response to treatment.The cost of measuring a factor as well as the reproduction of the measure must be taken intoaccount. The value of well-established prognostic factors determined after goodhistopathologic technique has been confirmed by a large number of studies and remains themost important.For operable breast tumors, the axillary involvement, the histoprognostic grade and the sizeof the tumor remain the most important prognostic factors. The value of S-phase fraction,angiogenesis and p53 overexpression has to be confirmed by prospective studies (Table14.7).For patients who have conservative treatment, the main factors of local breast relapse are :the presence of an extensive intraductal component and the involvement of the margins ofthe tumorectomy (Table 14.7).However, these prognostic factors may be modified with the use of new therapy. Theresponse to hormonal treatment is well correlated with the presence of hormonal receptors.The response to chemotherapy is associated with high proliferation, but other predictivefactors remain to be studied (c-erbB-2, MDR, ..) (Table 14.7).Research will not tend towards a multiplicity of factors of prognostic assessment but to aprecise determination of the most useful and reproducible factors using precise statisticalmethodology and to better treatment decisions individualized for each patient. The relativevalue of well-established prognostic factors may be modified in the future with the use ofbiological parameters as predictors of response to treatment and even as targets for newtreatments (immunotoxins, angiogenesis inhibitors....).Table 14.1. Disease-free survival of 398 inoperable carcinomas treatedat the Institut Gustave-RoussyCriteria Inflammatory Non inflammatory(n= 109) (n= 289)p valuep valueAge NS NSPEVO/1 - NSPEV2/3 0.09 -Tumor fixation NS NSClinical size NS 0.07Clinical nodes NS 10 -4Histologic type NS NSSBR grade 0.001 0.03IGR (Contesso 1987)Table 14.2. Disease-free survival at 10 years of 612 operable carcinomasTreated at the Institut Gustave-Roussy