The prognostic effect of histological tumor grade in node-negative breast cancer patients

Martin Schumacher, Claudia Schmoor, Willi Sauerbrei, Alfred Schauer, Lucia Ummenhofer, Wolfgang Gatzemeier, Helmut Rauschecker

Research output: Contribution to journalArticle

Abstract

The prognostic effect of histological tumor grade was evaluated in 1036 patients with early breast cancer (pT1 pN0 M0) entered into a trial comparing mastectomy and breast preserving treatment. All analyses were adjusted for the factors treatment, patients' age, and tumor size. Tumor grade was defined according to Bloom and Richardson based on the sum of scores assigned to each of three histological features: 1) degree of differentiation, 2) pleomorphism, and 3) mitotic index. The relative importance of these factors with regard to disease-free survival was evaluated. In univariate as well as in multivariate analyses the pleomorphism was the only factor showing a significant effect (univariate: p=0.0024, multivariate: p=0.015). It was investigated how the factors should be combined to define a histological grading score which yields the best possible classification of the patients with respect to prognosis. A new grading system was defined splitting the patients into three groups: 1) pleomorphism 1; 2) pleomorphism 2 or pleomorphism 3 and mitotic index 1; 3) pleomorphism 3 and mitotic index 2 or 3. This yields a good classification of the patients with respect to prognosis (p=0.0004). The prognostic effect of this score was compared with the effects of the grading systems proposed in the literature. According to Bloom and Richardson and in the modified version by Schauer and Weiss, grading is based on the sum of scores of the various histological factors. Therefore, the strong effect of the pleomorphism was diluted in these grading definitions (Bloom and Richardson: p=0.03, Schauer and Weiss: p=0.028). The grading system proposed by Le Doussal et al. consists only of the scores of pleomorphism and mitotic index (p=0.014). In summary, the factor pleomorphism showed a stronger effect on disease-free survival by itself than the grading systems proposed in the literature.

Original languageEnglish
Pages (from-to)235-245
Number of pages11
JournalBreast Cancer Research and Treatment
Volume25
Issue number3
DOIs
Publication statusPublished - Jan 1993

Keywords

  • breast cancer
  • Cox regression
  • histologic tumor grading
  • node negative
  • prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Schumacher, M., Schmoor, C., Sauerbrei, W., Schauer, A., Ummenhofer, L., Gatzemeier, W., & Rauschecker, H. (1993). The prognostic effect of histological tumor grade in node-negative breast cancer patients. Breast Cancer Research and Treatment, 25(3), 235-245. https://doi.org/10.1007/BF00689838