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PubMedDate not supplied

Using CommonKADS to create a conceptual model of a guideline system for breast cancer prognosis.

One of the major aspects in breast cancer research is the identification of prognostic factors accurate enough to define different therapeutic decisions; each prognostic factor on its own is insufficient for the prediction of the biological behaviour of the tumour, but a combination of these parameters is necessary. The work described here focuses on the definition of a conceptual knowledge model of the prognosis of breast cancer. Our approach to the conceptualization of the problem follows the CommonKADS (Knowledge Acquisition and Design Structuring) Library for Expertise Modelling. The aim of this work is to provide a first conceptualization of breast cancer prognosis while evaluating the efficacy of the CommonKADS methodology in facing the problem.

Artificial Intelligence↗
PubMed2003

Influence of tumor location on breast cancer prognosis.

Our objective was to investigate the influence of primary tumor location on breast cancer prognosis. We used a population-based registry since 1977 that has collected detailed information regarding clinical and histopathological presentation, postoperative therapy and follow-up status on Danish women with breast cancer. Nodal status and relative risk of dying was estimated according to primary tumor localization in the breast. Overall, 35319 patients with primary breast cancer were included in the study. After adjustment for prognostic factors, the risk of dying increased significantly (up to 21%) with increasing distance of tumor location from the axilla. This trend was seen both among women with and without spread to the axillary lymph nodes. In conclusion, survival is significantly better for women with a tumor in the upper lateral quadrant than tumors located elsewhere in the breast. Our finding of a similar trend according to distance from the axilla among women with positive axillary lymph nodes who all are allocated to systemic therapy suggests that a better lymph node staging procedure alone is unlikely to eliminate these survival differences. Other reasons for the observed differences should be sought to help improve survival for women with breast cancer.

Aged↗
PubMed1995

Gene diagnostics provide new insights into breast cancer prognosis and therapy.

Breast cancer is the most frequent cancer of women in developed countries. It is not surprising, therefore, that major research efforts have been made to improve early detection and treatment strategies directed at this malignancy. In this keynote article, we outline future perspectives on breast cancer genetics, risk factors and prognostic factors, focusing on novel developments relating to the estrogen receptor and the family of ErbB growth factor receptors.

Base Sequence↗
PubMedDate not supplied

Nuclear volume and breast cancer prognosis.

BACKGROUND: In breast cancer, nuclear volume estimates can be expected to be better prognosticators than nuclear profile areas because biological variation is wider in volume estimates than in area measurements. MATERIALS AND METHODS: 191 invasive breast cancer samples were available for nuclear volume measurements. To estimate the volume weighted mean nuclear volume, point-sampled linear intercepts were used on micrographs. The nuclear profile area was measured from 148 cases matching volume measurements and run by the Prodit morphometry program. Measurements were compared as prognosticators after a follow-up of 5 years. A computerized method on a randomly selected large number of nuclei was also applied in 17 cases. Bcl-2 immunostaining was compared with nuclear measurements. RESULTS: The correlation of volume and area measurements was statistically significant, but the correlation coefficients were low. The nuclear area showed a significant difference in survival at the 75 percentile cut-point but the volume-weighted mean nuclear volume did not allow distinction of different prognostic groups. Computerized volume measurements based on a large number of nuclei and measurements based on the simpler method did not show statistically significant correlation. Bcl-2 staining did not show any correlation with volume or area measurements. CONCLUSIONS: Although the prognostic value of nuclear area was shown in our study, the volume-weighted mean nuclear volume did not show prognostic significance. Improvement of the methodology which could decrease method variation and increase reproducibility of measurements is urgent for verification of the prognostic value of nuclear volume measurements. Bcl-2 immunostaining and nuclear area measurements were independent prognostic variables.

Breast Neoplasms↗
PubMed2007

Is the seasonal variation in cancer prognosis caused by sun-induced folate degradation?

Recently, we have documented that the season of diagnosis affects the prognosis of Hodgkin's lymphoma, colon-, breast- and prostate-cancer patients in Norway. The relative risk of death was lower for the patients diagnosed during summer and autumn when compared with the winter diagnosis. We here hypothesise that UV (ultraviolet) induced degradation of folate may be the reason for the observed seasonal variations in cancer prognosis. It is known that folic acid, a synthetic form of folate, is degraded by UV radiation. We have also found that the most common folate derivative in the human body, 5-methyltetrahydrofolate, is UV sensitive.

Folic Acid↗
PubMed2006

Polymorphisms in the glutathione S-transferase M1, T1, and P1 genes and prostate cancer prognosis.

BACKGROUND: Polymorphisms in glutathione S-transferase (GST) genes can increase oxidative stress, which may affect cancer prognosis. The aim of this study was to examine associations between GSTM1, T1, or P1 genetic variants and prostate cancer outcomes. METHODS: A population-based cohort of men (n = 752) from King County, Washington, diagnosed with prostate cancer in 1993-1996, and under long-term surveillance for mortality completed a follow-up survey about prostate cancer recurrence/progression. Cox PH models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for deaths from prostate cancer or other causes and prostate cancer recurrence/progression. RESULTS: There were 50 prostate cancer-specific deaths, 65 deaths from other causes, and 143 recurrence/progressions events during an average 9.6 years of follow-up. The adjusted HR for prostate cancer mortality was 3.8 (95% CI 1.6-8.9) among Caucasian men with the GSTM1-null genotype. There were no differences, however, in mortality from other causes or prostate cancer recurrence/progression between men with GSTM1-null versus not-null genotypes. The GSTT1 and GSTP1 genotypes were not associated with any of these outcomes. DISCUSSION: Results suggest that the GSTM1 genotype may be a useful biomarker to identify patients at higher risk for fatal prostate cancer.

Biomarkers, Tumor↗
PubMed1991

DNA ploidy and cell-cycle analysis: tools for assessment of cancer prognosis.

DNA ploidy and cell cycle analysis as measured by flow cytometry (FC) and image analysis (IA) have moved out of the realm of the research laboratory to become valid clinical tests used in the assessment of prognosis of the cancer patient. Although much information on the relationship of DNA ploidy/%S-phase analysis to patient prognosis is available in the literature, the data are not presented in such a way as to be helpful in clinical decision making. Because predictive values and confidence intervals, which measure the likelihood that a given clinical test will rule in or rule out a clinical outcome, were not calculated in previous reviews, conclusions about the clinical utility of these analyses were not possible. Using the available raw data on DNA ploidy and %S-phase analysis from previously published papers, predictive values and confidence limits were calculated for specific clinical presentations. In several such clinical situations (tumor type, stage, etc.), predictive value of greater than 90% was derived. We conclude that in these situations DNA ploidy and %S-phase analysis can be used to predict clinical outcome, to design treatment, and to guide patient management. The evaluation of the clinical utility of these tests must ultimately rest on prospective trials which show that randomized arms respond to treatment regimens dependent upon the DNA ploidy and %S-phase status.

Cell Cycle↗
PubMed1993

Chromatin organization and breast cancer prognosis. Two-dimensional and three-dimensional image analysis.

BACKGROUND: The assessment of breast cancer prognosis still relies on clinical staging and histologic grading. Among the different prognostic parameters, attention has been focused on features of chromatin structure. Although data from two-dimensional (2-D) analysis of chromatin structure show significant correlation with the survival, their biologic interpretation remains difficult. In this respect, insights into the spatial organization of chromatin appear important. METHODS: The authors performed computerized three-dimensional (3-D) reconstructions of Feulgen-stained tumor cell nuclei, correlating the results with those of 2-D image analysis. Forty-nine ductal-invasive carcinomas with 10-18 years follow-up were investigated. RESULTS: The 2-D analysis demonstrated that along with nuclear size and shape, chromatin features such as marginal concentration of condensed chromatin are of prognostic importance. As 3-D analysis revealed, chromatin changes concern ordered organization and were associated with the increase of spatial entropy. CONCLUSIONS: The 3-D description of chromatin structure by means of spatial models provides evidence that tumor aggressiveness correlates with events of clustering and randomization. These indicate disturbances of ordered chromatin organization.

Breast Neoplasms↗
PubMed2004

G388R mutation of the FGFR4 gene is not relevant to breast cancer prognosis.

This study screened large cohorts of node-positive and node-negative breast cancer patients to determine whether the G388R mutation of the FGFR4 gene is a useful prognostic marker for breast cancer as reported by Bange et al in 2002. Node-positive (n=139) and node-negative (n=95) breast cancer cohorts selected for mutation screening were followed up for median periods of 89 and 87 months, respectively. PCR - RFLP analysis was modified to facilitate molecular screening. Curves for disease-free survival were plotted according to the Kaplan - Meier method, and a log-rank test was used for comparisons between groups. Three other nonparametric linear rank-tests particularly suitable for investigating possible relations between G388R mutation and early cancer progression were also used. Kaplan - Meier analysis based on any of the four nonparametric linear rank tests performed for node-positive and node-negative patients was not indicative of disease-free survival time. G388R mutation of the FGFR4 gene is not relevant for breast cancer prognosis.

Adult↗
PubMed1981

Breast cancer prognosis and the sex of the patient's children.

To verify a report that the prognosis of breast cancer was better in women whose first child was male, we analyzed the survival of 233 consecutive breast cancer patients diagnosed in 1969 and 1970 in terms of the sex of the first and last children, and of the number and proportion of males among the first four live births. No association between survival and any index of the sex of children was found. Similar negative findings for both survival and time to first recurrence were found in an independent series of 113 patients.

Birth Order↗
PubMed1995

Gastric cancer: prognosis and lymph node reactivity.

OBJECTIVE: To assess the prognostic value of various immunomorphological variables in the prognosis of gastric cancer after curative resection. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: 180 Patients who underwent curative resection for carcinoma of the distal two thirds of stomach between January 1960 and December 1978. Curative was defined as no residual cancer at the resection margins and no distant metastases. INTERVENTIONS: All living patients were followed-up, and missing survival data were obtained from the Official Census Registry. MAIN OUTCOME MEASURES: Correlation between survival and nuclear grade, lymphocytic infiltration, and types of lymph node reaction such as sinus histiocytosis, paracortical lymphoid cellular hyperplasia, and follicular hyperplasia in the cortical area. RESULTS: Crude 5 year and 10 year survival rates were 46% and 36%, respectively. Sex, site, and histological type of the tumour did not correlate with survival. Multivariate analysis showed that only pTNM stage of disease and degree of sinus histiocytosis were significantly related to survival. CONCLUSION: There may be an argument for using the presence or absence of sinus histiocytosis to stratify patients in prospective studies of adjuvant treatment.

Female↗
PubMed1992

Rheumatoid factor isotypes and cancer prognosis.

The relationship between rheumatoid factor (RF) and cancer was studied during a long-term health survey done in the Reykjavik area of Iceland since 1967. A total of 16,299 blood samples from 13,858 persons attending this health survey between 1974 and 1983 were screened for the presence of RF. In 1987, RF-positive participants in this study (n = 270) and matched RF-negative control subjects (n = 223) were evaluated for incidence and prognosis of cancer with information obtained from the comprehensive Icelandic Cancer Registry. The average observation time for this cohort was 9.3 years. Participants with raised immunoglobulin A RF in their original blood sample showed an increased risk of having cancer compared with both other members of the cohort and the national cancer incidence. Their total mortality was also higher during the study period. By contrast, patients with cancer and elevated immunoglobulin M RF before the diagnosis of cancer were more likely to survive than those who were immunoglobulin M RF negative. Cancer incidence in the RF-negative control group was not different from the expected national incidence of cancer in Iceland for that age group. It is suggested that elevation of immunoglobulin A RF is an adverse phenomenon in relation to cancer; elevation of immunoglobulin M RF is associated with a favorable prognosis.

Agglutination Tests↗
PubMed2004

Potential rapid assessment of breast cancer prognosis using induced chromosome condensation performed on cytological specimens.

We have previously shown that assessment of chromosome alteration rate by cytogenetics is well correlated with breast cancer prognosis factors. As karyotypes are usually difficult to obtain from solid tumors using conventional methods, a new approach is proposed. Metaphase-like chromosomes were directly obtained following chromosome condensation using calyculin A (okadaic acid) from cytologic specimens of breast cancers sampled by fine needle. Chromosome counts and rearrangement rates were established in a series of 45 tumors, as early as 24-48 h after sampling. A high rate of rearranged chromosomes was found to correlate with high histological grade, TNM stage and S-phase fraction, loss of estrogen receptor expression and DNA aneuploidy. The indication of genome alteration provided by this method constitutes a simple, potent and early potential prognostic factor in breast cancer directly applied on cytological specimens.

Adult↗
PubMed2001

EGFR and cancer prognosis.

Elevated levels of the epidermal growth factor receptor (EGFR), a growth-factor-receptor tyrosine kinase, and/or its cognate ligands have been identified as a common component of multiple cancer types and appear to promote solid tumour growth. This article examines the relationship between EGFR expression and cancer prognosis based on literature compiled on PubMed between 1985 and September 2000. More than 200 studies were identified that analysed relapse-free-interval or survival data directly in relation to EGFR levels in over 20000 patients. Analysis of the data showed that 10 cancer types both express elevated levels of EGFR relative to normal tissues and have been studied in sufficient depth to allow sound judgements to be made concerning the association between EGFR and patient outlook. The EGFR was found to act as a strong prognostic indicator in head and neck, ovarian, cervical, bladder and oesophageal cancers. In these cancers, increased EGFR expression was associated with reduced recurrence-free or overall survival rates in 70% (52/74) of studies. In gastric, breast, endometrial and colorectal cancers, the EGFR provided more modest prognostic information, correlating to poor survival rates in 52% (13/25) of studies, while in non-small cell lung cancer (NSCLC), EGFR expression only rarely (3/10 studies) related to patient outlook. However, it is likely that the true prognostic significance of the EGFR has been underestimated as the published studies only assessed total cellular EGFR levels, rather than the activated form of the receptor, and were not standardised with regard to patient populations or assay methods. Finally, it is important to stress that failure to detect a prognostic significance for EGFR in any one cancer type does not necessarily preclude patients from benefiting from anti-EGFR therapies.

Biomarkers, Tumor↗
PubMed2002

[Breast cancer prognosis in Tunisian women: analysis of a hospital series of 729 patients].

The objective of this study was to identify the anatomical-clinical aspects and determine the prognostic factors for breast cancer in the central region of Tunisia. This retrospective study involved 729 patients suffering from breast cancer, proven either by histology or cytology, diagnosed and treated between January 1990 and June 1998 at the F. Hached University Hospital in Sousse, Tunisia. The patients' average age was 50 years (ranging from 22-91). The average size of the cancer at the time of diagnosis was 49.1 mm; 90% were invasive duct carcinoma with high histo-prognostic SBR grade (level II-III: 86%). The overall survival rate was 50.5% after five years, and 50% after seven years. Using univariate analysis, significant predictive value was found with the following factors: tumor size, the clinical ganglionic level, metastases at diagnosis, the number of nodes invaded, nodal capsular rupture and lymphatic embolism, SBR grade and the delay in seeking consultation. The multivariate analysis (Cox model) isolated two prognostic factors: the initial size of the tumor (p = 0.001) and metastases at the time of diagnosis (p = 0.01). The study's results indicated that breast cancer prognosis in Tunisia remains poor primarily due to late diagnosis.

Adult↗
PubMed2004

Breast cancer prognosis in relation to family history of breast and ovarian cancer.

We linked four nationwide Swedish population-based registries to identify first-degree family history of breast and ovarian cancer among breast cancer cases diagnosed between 1991 and 1998 and followed them until death, emigration or end of follow-up in December 1998. The median follow-up was 36 months. Using Cox proportional hazards models, the hazard ratio of death (HR) due to breast cancer was estimated. Women with a family history of breast or ovarian cancer (n=2175, 12.7%) had a nonsignificantly better prognosis than women without any family history, HR 0.86 (95% CI 0.71-1.05); this appeared unrelated to age at diagnosis either in the index case or in relative(s) with breast and/or ovarian cancer. Our study shows that prognostic outlook is not worse among breast cancer patients with family history.

Breast Neoplasms↗