McCallum et al studied women with operable breast cancer and negative lymph nodes. They identified pathologic features associated with a good or bad outcome. The authors are from South Glasgow University Hospitals, University of St Andrews, Lothian University, University of Glasgow, Ninewells Hospital and Medical School, and the Common Services Agency of the NHS in Scotland.
Patient selection: small, operable breast cancer with negative lymph nodes
Outcome: good if survival was >= 10 years without evidence of disease. Poor outcome was distant metastases within 6 years of diagnosis. There would be an intermediate outcome between these 2 groups.
Significance: The prognosis for a patient with a poor outcome is improved by adjuvant chemotherapy. A patient with a good outcome can avoid the toxicity of chemotherapy.
Parameters:
(1) histologic grade (I, II or III; scored as 1, 2 3)
(2) immunostaining with cyclin D1 (Santa Cruz SC 6281)
(3) immunostaining with p27 (Santa Cruz SC 1641)
(4) immunostaining with BCL-2 (Dako M0887)
Over-expression of cyclin D1 is favorable prognostic factor and is associated with Grade I, estrogen receptor (ER) positive tumors.
Over-expression of p27 is associated with favorable outcome (acts as tumor suppressor).
Over-expression of BCL-2 is associated with a favorable outcome.
Immunostaining is scored based on the percent of cells that show positive staining.
(1) strong staining: >= 70% (scored 1 point)
(2) moderate staining: 31-69% (scored 2 points)
(3) weak staining: <= 30% (scored 3 points)
total aggregate score =
= (points for histological grade) + (points for cyclin D1) + (points for p27) + (points for BCL2)
Interpretation:
• minimum score: 4
• maximum score: 12
• An aggregate score < 10 was associated with a good outcome (53 good, 14 poor).
• An aggregate score >= 10 was associated with a poor outcome (10 good, 29 poor).
Alternatively, a classification tree was prepared for women treated with tamoxifen.
|
Histo Grade
|
Cyclin D1
|
p27
|
BCL-2
|
Percent Good
|
|
I or II
|
NA
|
NA
|
NA
|
81%
|
|
III
|
>= 75%
|
NA
|
NA
|
64%
|
|
III
|
< 75%
|
>= 55%
|
NA
|
0%
|
|
III
|
< 75%
|
< 55%
|
>= 5%
|
64%
|
|
III
|
< 75%
|
< 55%
|
< 5%
|
20%
|
