TAILIEUCHUNG - Chapter 086. Breast Cancer (Part 7)

Table 86-2 5-Year Survival Rate for Breast Cancer by Stage Stage 5-Year Survival, % 0 99 I 92 IIA 82 IIB 65 IIIA 47 IIIB 44 IV 14 Source: Modified from data of the National Cancer Institute—Surveillance, Epidemiology, and End Results (SEER). Estrogen and progesterone receptor status are of prognostic significance. Tumors that lack either or both of these receptors are more likely to recur than tumors that have them. Several measures of tumor growth rate correlate with early relapse. S-phase analysis using flow cytometry is the most accurate measure. Indirect S-phase assessments using antigens associated with the cell cycle, such as PCNA (Ki67), are also valuable. Tumors with a high proportion (more than the median) of cells in. | Chapter 086. Breast Cancer Part 7 aTable 86-2 5-Year Survival Rate for Breast Cancer by Stage Stage 5-Year Survival 0 99 I 92 IIA 82 IIB 65 IIIA 47 IIIB 44 IV 14 Source Modified from data of the National Cancer Institute Surveillance Epidemiology and End Results SEER . Estrogen and progesterone receptor status are of prognostic significance. Tumors that lack either or both of these receptors are more likely to recur than tumors that have them. Several measures of tumor growth rate correlate with early relapse. S-phase analysis using flow cytometry is the most accurate measure. Indirect S-phase assessments using antigens associated with the cell cycle such as PCNA Ki67 are also valuable. Tumors with a high proportion more than the median of cells in S phase pose a greater risk of relapse chemotherapy offers the greatest survival benefit for these tumors. Assessment of DNA content in the form of ploidy is of modest value with nondiploid tumors having a somewhat worse prognosis. Histologic classification of the tumor has also been used as a prognostic factor. Tumors with a poor nuclear grade have a higher risk of recurrence than tumors with a good nuclear grade. Semiquantitative measures such as the Elston score improve the reproducibility of this measurement. Molecular changes in the tumor are also useful. Tumors that overexpress erbB2 HER-2 neu or have a mutated p53 gene have a worse prognosis. Particular interest has centered on erbB2 overexpression as measured by histochemistry or by fluorescence in situ hybridization. Tumors that overexpress erbB2 are more likely to respond to higher doses of doxorubicin-containing regimens and predict those tumors that will respond to HER-2 neu antibodies trastuzumab herceptin and a Her-2 neu kinase inhibitor. To grow tumors must generate a neovasculature Chap. 80 . The presence of more microvessels in a tumor particularly when localized in so-called hot spots is associated with a worse prognosis. This may assume even greater .

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