Whether the proliferative activity of distant metastases could be predicted by the proliferation in axillary lymph node metastases was investigated in 304 lymph nodes metastases of 52 patients with breast cancer who had not received adjuvant treatment. The standard deviation of the mean mitotic index (MI)--the average number of mitoses per field in 10 high power fields--was of the best prognostic valve in univariate survival analysis. None of the classic (volume % epithelium and stroma) or morphometric features (nuclear area, nuclear axis ratio. shape factors) provided significant results. In Cox regression analysis a multivariate combination of the mean MI, the SD of the mean MI, and the maximum MI emerged, which provided a satisfying means of differentiating patients with a good (68% survival) and a poor (28% survival) prognosis. Proliferation variables derived from axillary lymph node metastases of patients with breast cancer can predict the clinical course of distant metastases.
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