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Indicators of loco-regional recurrence in breast cancer
Department of Surgery, County Hospital, Kalmar, Sweden.
Department of Cytology and Pathology, County Hospital, Kalmar, Sweden.
Linköping University, Department of Biomedicine and Surgery, Oncology. Linköping University, Faculty of Health Sciences.
Department of Physiology, County Hospital, Kalmar, Sweden.
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2000 (English)In: European Journal of Surgical Oncology, ISSN 0748-7983, E-ISSN 1532-2157, Vol. 26, no 4, 357-362 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of the investigation was to contribute to the identification of patients who have increased or decreased risk of loco-regional recurrence.

Methods: Six hundred and twenty-nine consecutive patients with primary breast cancer diagnosed between 1988 and 1990 were studied. Two-thirds of the patients underwent mastectomy. Radiotherapy was administered if patients were node positive or breast conserved. The Nottingham histological grading protocol was used and presence of lymphovascular invasion was assessed. Investigated parameters were: age, size, grade, steroid receptor content, surgical radicality, vascular invasion and nodal status. Statistically significant risk factors for loco-regional recurrence using univariate or Cox proportional hazard analysis were grade and lymphovascular invasion.

Results: Women with grade 1-2, node-negative tumours without vascular invasion had a very low loco-regional recurrence rate - 3.1%. Seventeen percent of patients with grade 3 tumours and vessel invasion had loco-regional recurrence.

Conclusions: Our findings, and those of others, indicate that the use of adjuvant radiotherapy should be influenced to a greater extent by grade and lymphovascular invasion.

Place, publisher, year, edition, pages
2000. Vol. 26, no 4, 357-362 p.
Keyword [en]
breast cancer, recurrence, lymphovascular invasion, Nottingham histological grade
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-25179DOI: 10.1053/ejso.1999.0898Local ID: 9616OAI: diva2:245506
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-08-09Bibliographically approved
In thesis
1. Prognostic Factors in Breast Cancer
Open this publication in new window or tab >>Prognostic Factors in Breast Cancer
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Breast cancer is increasing in the industrialised countries. Due to early detection and adjuvaut treatment with radiotherapy, hormones and chemotherapy, mortality has decreased. The different adjuvant treatments have adverse effects. It is an important task is to estimate the risk of recurrence for the individual patient in order to tailor her individual treatment. This thesis aims at identifying predictors for disease development in primary and disseminated breast cancer.

Histologic grade was strongly correlated to breast cancer mortality in 630 patients with primary breast cancer. The combination of grade, tumour size and lymph node status in the Nottingham Prognostic Index provides a powerful instrument separating patients in groups with excellent, good, intermediate and poor prognosis.

Grade was more sensitive than S-phase fraction in identifying high risk patients and patients with very good prognosis.

Presence of cancer cells in blood- and lymph vessels close to the tumour in patients with grade 3 tumours increased the risk oflocoregional recurrence 6-fold as compared to patients with grade 1 or 2 tumours without such vascular invasion.

The mortality of young women with breast cancer has decreased very little since 1960. Women under 37 years of age had increased tumour size, more metastatic lymph nodes and doubled rate of high grade tumours as compared to older women.

Disease-free interval and survival in patients with distant recurrence were strongly associated to histologic grade and hormone receptor content. Patients with grade 3, hormone receptor negative tumours had a median survival of 10 months after recurrence while only 15 % of women with receptor positive, grade 1 tumours have so far died after a median follow-up time of 5 years after recurrence.

The Nottingham Prognostic Index and assessments of presence of tmnour cells in vessels provide important information about the risk oflocoregional and distant recurrence in breast cancer. Treatment decisions, counselling and follow-up programmes should be based on such assessments. For patients with metastatic breast cancer, tumour grade, estrogen receptor status and serum-c-erbB-2 predict the course of the disease.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2000. 64 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 632
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-25716 (URN)10093 (Local ID)91-7219-589-4 (ISBN)10093 (Archive number)10093 (OAI)
Public defence
2000-05-26, Ögonklinikens föreläsningssal, Universitetssjukhuset, Linköping, 13:00 (Swedish)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-08-09Bibliographically approved

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Sundquist, MarieThorstenson, StenKlintenberg, ClaesBrudin, LarsNordenskjöld, Bo
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