The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy

S. E. Pinder, S. Murray, I. O. Ellis, H. Trihia, C. W. Elston, R. D. Gelber, A. Goldhirsch, J. Lindtner, H. Cortés-Funes, E. Simoncini, M. J. Byrne, R. Golouh, C. M. Rudenstam, M. Castiglione-Gertsch, B. A. Gusterson

Research output: Contribution to journalArticle

Abstract

BACKGROUND. Histologic grade is well recognized for its prognostic significance in cases of primary operable invasive breast carcinoma; however, the majority of studies in which grade has been assessed have been based on single-center trials. In addition, the role of grade in predicting response to chemotherapy has not been examined in many previous studies. METHODS. The authors assessed the value of Nottingham histologic grade (NHG) in a group of 465 patients enrolled in a multicenter, randomized International Breast Cancer Study Group clinical trial of adjuvant chemotherapy for patients with lymph node (LN) positive and LN negative primary breast carcinoma (formerly named Ludwig Trial V). RESULTS. NHG was a predictor of overall survival for both LN negative and LN positive patients (P = 0.045 and P <0.001, respectively). NHG was associated with a poorer prognosis for both LN positive and LN negative patients, with hazard ratios of 1.651 (P <0.001) and 1.437 (P = 0.045), respectively, for an increase of one grade. Among LN negative patients, this survival disadvantage was observed only for those who received perioperative chemotherapy. For LN positive patients, an increase of one grade resulted in a significant overall survival disadvantage regardless of whether prolonged or perioperative chemotherapy was given. For LN negative patients grouped by grade, there was no observed difference in overall or disease free survival according to whether perioperative chemotherapy or no adjuvant therapy was given. However, LN positive patients with Grade 3 tumors had a significantly greater overall and disease free survival benefit from prolonged chemotherapy than from perioperative chemotherapy (P = 0.016 and P = 0.013, respectively); LN positive patients with Grade I or 2 disease in both treatment arms had comparable overall and disease free survival. A strong correlation between the previously utilized Bloom-Richardson grading system (BRG) and NHG was observed (P <0.001 and κ = 82%) and no apparent differences in overall and disease free survival were observed between the two systems. NHG did, however, identify a greater proportion of tumors as Grade 1, and BRG identified a greater proportion of breast carcinomas as Grade 3. CONCLUSIONS. This multicenter clinical study confirms the value of histologic grade, and the authors propose that this technique be used to identify Grade 3, LN positive patients who will benefit from prolonged rather than perioperative chemotherapy.

Original languageEnglish
Pages (from-to)1529-1539
Number of pages11
JournalCancer
Volume83
Issue number8
DOIs
Publication statusPublished - Oct 15 1998

Fingerprint

Lymph Nodes
Breast Neoplasms
Drug Therapy
Disease-Free Survival
Survival
Adjuvant Chemotherapy
Multicenter Studies
Neoplasms
Clinical Trials
Therapeutics

Keywords

  • Breast carcinoma
  • Chemotherapy
  • Histologic grade
  • Prognosis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Pinder, S. E., Murray, S., Ellis, I. O., Trihia, H., Elston, C. W., Gelber, R. D., ... Gusterson, B. A. (1998). The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. Cancer, 83(8), 1529-1539. https://doi.org/10.1002/(SICI)1097-0142(19981015)83:8<1529::AID-CNCR7>3.0.CO;2-V

The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. / Pinder, S. E.; Murray, S.; Ellis, I. O.; Trihia, H.; Elston, C. W.; Gelber, R. D.; Goldhirsch, A.; Lindtner, J.; Cortés-Funes, H.; Simoncini, E.; Byrne, M. J.; Golouh, R.; Rudenstam, C. M.; Castiglione-Gertsch, M.; Gusterson, B. A.

In: Cancer, Vol. 83, No. 8, 15.10.1998, p. 1529-1539.

Research output: Contribution to journalArticle

Pinder, SE, Murray, S, Ellis, IO, Trihia, H, Elston, CW, Gelber, RD, Goldhirsch, A, Lindtner, J, Cortés-Funes, H, Simoncini, E, Byrne, MJ, Golouh, R, Rudenstam, CM, Castiglione-Gertsch, M & Gusterson, BA 1998, 'The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy', Cancer, vol. 83, no. 8, pp. 1529-1539. https://doi.org/10.1002/(SICI)1097-0142(19981015)83:8<1529::AID-CNCR7>3.0.CO;2-V
Pinder, S. E. ; Murray, S. ; Ellis, I. O. ; Trihia, H. ; Elston, C. W. ; Gelber, R. D. ; Goldhirsch, A. ; Lindtner, J. ; Cortés-Funes, H. ; Simoncini, E. ; Byrne, M. J. ; Golouh, R. ; Rudenstam, C. M. ; Castiglione-Gertsch, M. ; Gusterson, B. A. / The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy. In: Cancer. 1998 ; Vol. 83, No. 8. pp. 1529-1539.
@article{6e7b9d12448442f3a90cc0f0fcbfaedc,
title = "The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy",
abstract = "BACKGROUND. Histologic grade is well recognized for its prognostic significance in cases of primary operable invasive breast carcinoma; however, the majority of studies in which grade has been assessed have been based on single-center trials. In addition, the role of grade in predicting response to chemotherapy has not been examined in many previous studies. METHODS. The authors assessed the value of Nottingham histologic grade (NHG) in a group of 465 patients enrolled in a multicenter, randomized International Breast Cancer Study Group clinical trial of adjuvant chemotherapy for patients with lymph node (LN) positive and LN negative primary breast carcinoma (formerly named Ludwig Trial V). RESULTS. NHG was a predictor of overall survival for both LN negative and LN positive patients (P = 0.045 and P <0.001, respectively). NHG was associated with a poorer prognosis for both LN positive and LN negative patients, with hazard ratios of 1.651 (P <0.001) and 1.437 (P = 0.045), respectively, for an increase of one grade. Among LN negative patients, this survival disadvantage was observed only for those who received perioperative chemotherapy. For LN positive patients, an increase of one grade resulted in a significant overall survival disadvantage regardless of whether prolonged or perioperative chemotherapy was given. For LN negative patients grouped by grade, there was no observed difference in overall or disease free survival according to whether perioperative chemotherapy or no adjuvant therapy was given. However, LN positive patients with Grade 3 tumors had a significantly greater overall and disease free survival benefit from prolonged chemotherapy than from perioperative chemotherapy (P = 0.016 and P = 0.013, respectively); LN positive patients with Grade I or 2 disease in both treatment arms had comparable overall and disease free survival. A strong correlation between the previously utilized Bloom-Richardson grading system (BRG) and NHG was observed (P <0.001 and κ = 82{\%}) and no apparent differences in overall and disease free survival were observed between the two systems. NHG did, however, identify a greater proportion of tumors as Grade 1, and BRG identified a greater proportion of breast carcinomas as Grade 3. CONCLUSIONS. This multicenter clinical study confirms the value of histologic grade, and the authors propose that this technique be used to identify Grade 3, LN positive patients who will benefit from prolonged rather than perioperative chemotherapy.",
keywords = "Breast carcinoma, Chemotherapy, Histologic grade, Prognosis",
author = "Pinder, {S. E.} and S. Murray and Ellis, {I. O.} and H. Trihia and Elston, {C. W.} and Gelber, {R. D.} and A. Goldhirsch and J. Lindtner and H. Cort{\'e}s-Funes and E. Simoncini and Byrne, {M. J.} and R. Golouh and Rudenstam, {C. M.} and M. Castiglione-Gertsch and Gusterson, {B. A.}",
year = "1998",
month = "10",
day = "15",
doi = "10.1002/(SICI)1097-0142(19981015)83:8<1529::AID-CNCR7>3.0.CO;2-V",
language = "English",
volume = "83",
pages = "1529--1539",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "8",

}

TY - JOUR

T1 - The importance of the histologic grade of invasive breast carcinoma and response to chemotherapy

AU - Pinder, S. E.

AU - Murray, S.

AU - Ellis, I. O.

AU - Trihia, H.

AU - Elston, C. W.

AU - Gelber, R. D.

AU - Goldhirsch, A.

AU - Lindtner, J.

AU - Cortés-Funes, H.

AU - Simoncini, E.

AU - Byrne, M. J.

AU - Golouh, R.

AU - Rudenstam, C. M.

AU - Castiglione-Gertsch, M.

AU - Gusterson, B. A.

PY - 1998/10/15

Y1 - 1998/10/15

N2 - BACKGROUND. Histologic grade is well recognized for its prognostic significance in cases of primary operable invasive breast carcinoma; however, the majority of studies in which grade has been assessed have been based on single-center trials. In addition, the role of grade in predicting response to chemotherapy has not been examined in many previous studies. METHODS. The authors assessed the value of Nottingham histologic grade (NHG) in a group of 465 patients enrolled in a multicenter, randomized International Breast Cancer Study Group clinical trial of adjuvant chemotherapy for patients with lymph node (LN) positive and LN negative primary breast carcinoma (formerly named Ludwig Trial V). RESULTS. NHG was a predictor of overall survival for both LN negative and LN positive patients (P = 0.045 and P <0.001, respectively). NHG was associated with a poorer prognosis for both LN positive and LN negative patients, with hazard ratios of 1.651 (P <0.001) and 1.437 (P = 0.045), respectively, for an increase of one grade. Among LN negative patients, this survival disadvantage was observed only for those who received perioperative chemotherapy. For LN positive patients, an increase of one grade resulted in a significant overall survival disadvantage regardless of whether prolonged or perioperative chemotherapy was given. For LN negative patients grouped by grade, there was no observed difference in overall or disease free survival according to whether perioperative chemotherapy or no adjuvant therapy was given. However, LN positive patients with Grade 3 tumors had a significantly greater overall and disease free survival benefit from prolonged chemotherapy than from perioperative chemotherapy (P = 0.016 and P = 0.013, respectively); LN positive patients with Grade I or 2 disease in both treatment arms had comparable overall and disease free survival. A strong correlation between the previously utilized Bloom-Richardson grading system (BRG) and NHG was observed (P <0.001 and κ = 82%) and no apparent differences in overall and disease free survival were observed between the two systems. NHG did, however, identify a greater proportion of tumors as Grade 1, and BRG identified a greater proportion of breast carcinomas as Grade 3. CONCLUSIONS. This multicenter clinical study confirms the value of histologic grade, and the authors propose that this technique be used to identify Grade 3, LN positive patients who will benefit from prolonged rather than perioperative chemotherapy.

AB - BACKGROUND. Histologic grade is well recognized for its prognostic significance in cases of primary operable invasive breast carcinoma; however, the majority of studies in which grade has been assessed have been based on single-center trials. In addition, the role of grade in predicting response to chemotherapy has not been examined in many previous studies. METHODS. The authors assessed the value of Nottingham histologic grade (NHG) in a group of 465 patients enrolled in a multicenter, randomized International Breast Cancer Study Group clinical trial of adjuvant chemotherapy for patients with lymph node (LN) positive and LN negative primary breast carcinoma (formerly named Ludwig Trial V). RESULTS. NHG was a predictor of overall survival for both LN negative and LN positive patients (P = 0.045 and P <0.001, respectively). NHG was associated with a poorer prognosis for both LN positive and LN negative patients, with hazard ratios of 1.651 (P <0.001) and 1.437 (P = 0.045), respectively, for an increase of one grade. Among LN negative patients, this survival disadvantage was observed only for those who received perioperative chemotherapy. For LN positive patients, an increase of one grade resulted in a significant overall survival disadvantage regardless of whether prolonged or perioperative chemotherapy was given. For LN negative patients grouped by grade, there was no observed difference in overall or disease free survival according to whether perioperative chemotherapy or no adjuvant therapy was given. However, LN positive patients with Grade 3 tumors had a significantly greater overall and disease free survival benefit from prolonged chemotherapy than from perioperative chemotherapy (P = 0.016 and P = 0.013, respectively); LN positive patients with Grade I or 2 disease in both treatment arms had comparable overall and disease free survival. A strong correlation between the previously utilized Bloom-Richardson grading system (BRG) and NHG was observed (P <0.001 and κ = 82%) and no apparent differences in overall and disease free survival were observed between the two systems. NHG did, however, identify a greater proportion of tumors as Grade 1, and BRG identified a greater proportion of breast carcinomas as Grade 3. CONCLUSIONS. This multicenter clinical study confirms the value of histologic grade, and the authors propose that this technique be used to identify Grade 3, LN positive patients who will benefit from prolonged rather than perioperative chemotherapy.

KW - Breast carcinoma

KW - Chemotherapy

KW - Histologic grade

KW - Prognosis

UR - http://www.scopus.com/inward/record.url?scp=15644376845&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=15644376845&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1097-0142(19981015)83:8<1529::AID-CNCR7>3.0.CO;2-V

DO - 10.1002/(SICI)1097-0142(19981015)83:8<1529::AID-CNCR7>3.0.CO;2-V

M3 - Article

C2 - 9781946

AN - SCOPUS:15644376845

VL - 83

SP - 1529

EP - 1539

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 8

ER -