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

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Summary

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 Doussalet 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.

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Authors and Affiliations

  1. For the German Breast Cancer Study Group: Institute of Medical Biometry and Informatics, University of Freiburg, Stefan-Meier-Str. 26, D-7800, Freiburg, Germany

    Martin Schumacher, Claudia Schmoor & Willi Sauerbrei

  2. For the German Breast Cancer Study Group: Institute of Pathology, University of Göttingen, Germany

    Alfred Schauer & Lucia Ummenhofer

  3. For the German Breast Cancer Study Group: Department of Surgery, University of Göttingen, Germany

    Wolfgang Gatzemeier & Helmut Rauschecker

Authors
  1. Martin Schumacher
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  2. Claudia Schmoor
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  3. Willi Sauerbrei
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  4. Alfred Schauer
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  5. Lucia Ummenhofer
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  6. Wolfgang Gatzemeier
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  7. Helmut Rauschecker
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Schumacher, M., Schmoor, C., Sauerbrei, W. et al. The prognostic effect of histological tumor grade in node-negative breast cancer patients. Breast Cancer Res Tr 25, 235–245 (1993). https://doi.org/10.1007/BF00689838

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