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Query: UMLS:C0677930 (primary tumor)
 20,210 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pathologic materials were available for review from 1597 women with Stage II (positive regional node metastases) invasive breast cancer in whom estrogen receptor (ER) and progesterone receptor (PR) assays of the primary tumor were performed. These women were enrolled in a clinical trial comparing the effect of postmastectomy adjuvant L-phenylalanine mustard (L-PAM) and 5-fluorouracil (5-FU) with and without tamoxifen (NSABP Protocol No. 9). Significant pathologic and clinical associations with receptor status were similar for both ER and PR except that the latter, unlike ER, was not related to patient age. Regression analyses revealed that the most significant pathologic features related to a concordant positive ERPR receptor status was low (well differentiated) nuclear and histologic grades, slight or absent tumor lymphoid infiltrate, slight or absent necrosis and moderate or marked elastica in decreasing order of importance. All of the factors enumerated are directly or indirectly related to tumor differentiation. Recognition of four or five conforming pathologic features allows for the prediction of either ER or PR status in 70% to 80% of instances respectively, and the presence of three features in 69%. This latter figure is similar to that of estimation of nuclear grade alone. Thirty percent of ERPR estimates were discordant i.e., either ER-PR+ or ER+PR-. Pathologic features associated with discordant assays were not similar to those found when the ERPR estimates were concordant. Life table analyses revealed patients with discordant receptors to exhibit disease-free survival intermediate to that of those with ER+PR+ and ER-PR- values. This information suggests that a discordant receptor status is more reflective of an aberration of ER metabolism than a methodologic error. Histograms correlating frequency of nuclear grades with levels of ER and PR were comparable and revealed patterns indicating the propriety of relating values less than 10 fm/mg as being receptor negative. The frequency of well-differentiated nuclei increased with ascending levels of ER and PR.
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PMID:Pathologic findings from the national surgical adjuvant breast project. Correlations with concordant and discordant estrogen and progesterone receptors. 382 55

To assess the prognostic significance of peritumoral vessel invasion, data were examined for 1,510 women entered into the Ludwig Breast Cancer Group Trials I to IV evaluating adjuvant therapy for operable breast cancer with axillary nodal metastasis. Vessel invasion by tumor cells was identified by routine light microscopy in 59 per cent (889 of 1,510) of the patients and was equally distributed between premenopausal/perimenopausal (60 per cent, 468 of 778) and postmenopausal (58 per cent, 421 of 732) women. In logrank analyses stratified by nodal status (one to three or four or more positive nodes), the four-year disease-free survival (DFS) rate was significantly lower in patients with vessel invasion than in women without vessel invasion (50 per cent versus 65 per cent, P less than 0.0001). This DFS difference was seen for both premenopausal/perimenopausal (P = 0.0004) and postmenopausal (P = 0.0002) patients. The four-year overall survival rate was also lower in patients with vessel invasion (71 per cent versus 82 per cent, P = 0.0006), both for premenopausal/perimenopausal (P = 0.002) and postmenopausal (P = 0.04) women. The presence of vessel invasion was significantly associated with increasing numbers of positive axillary lymph nodes, rising tumor grade, nonstellate tumor border growth pattern, and higher steroid hormone receptor content of the primary tumor. The assessment of peritumoral vessel invasion continued to have prognostic significance for DFS (P less than 0.0001) and overall survival (P = 0.003) when evaluated in multivariate models controlling for treatment assigned, nodal status, tumor size, estrogen receptor status, menopausal status, and age. Depending on the subpopulation, patients with vessel invasion had a 41 per cent to 54 per cent greater risk of treatment failure than those without vessel invasion and a 29 per cent to 64 per cent greater risk of death. The percentage of treatment failures at distant sites was higher for women with than for those without vessel invasion (27 per cent versus 18 per cent, P = 0.003). In patients with axillary lymph node metastases, peritumoral vessel invasion may be a sign of increased systemic disease burden.
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PMID:Prognostic significance of peritumoral vessel invasion in clinical trials of adjuvant therapy for breast cancer with axillary lymph node metastasis. 390 76

The cytosolic estrogen receptor (ER) content of the primary tumor was determined by isoelectric focusing in 170 consecutive women with unilateral breast cancer diagnosed in 1977 through 1980. No adjuvant treatment over and above surgery and radiotherapy was given. The overall corrected survival was not significantly (p greater than 0.05) higher in ER-rich (less than 0.1 nmol/g DNA) than in ER-poor tumors, but the median period from recurrence to death was longer in the former (16 months) than in the latter (10 months) group. The difference in disease-free survival (DFS) in favour of the ER-rich tumors achieved its maximum-about 15%-after two years (p less than 0.01). At prolonged follow-up, however, the curves converged and there was no significant difference when the whole six year period of observation was taken into account. In patients without axillary metastases the same pattern emerged, with earlier recurrences in ER-poor tumors and a difference in DFS between the two ER groups at two years (p less than 0.01) which was diminished after five years (p less than 0.05). The ER content provided no significant prognostic information in patients with axillary node metastases or locally advanced disease. We conclude from the present and other available data that the ER content in breast cancer would seem to be an indicator of growth rate rather than of metastatic potential and accordingly a predictor of the pattern of recurrence and length of disease-free survival rather than of long-term survival.
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PMID:Prognostic implication of estrogen receptor content in breast cancer. 402 96

The relationship of clinically defined menstrual categories and an independent measure of hormonal stimulation, maturation index of vaginal smear cytology, was studied. Analysis of 596 smears obtained at the time of breast cancer diagnosis revealed a statistically significant association between menstrual status and maturation index. However, within each menstrual group varying levels of maturation were noted. Estrogenic effect in the absence of exogenous hormone administration was found in 11% of patients following bilateral oophorectomy and among 24% of women whose natural menopause occurred 20 years or longer prior to diagnosis. Endogenous estrogen production appears to continue for many years among some women. Clinical factors such as obesity, diabetes and/or hypertension may stimulate high squamous maturation in some patients. Others of the same age and with similar clinical histories were found to have atrophic smears. The differences in maturation index may be due to individual variations in: endogenous hormone levels; sensitivity of the vaginal mucosa to similar hormonal stimuli; use of certain medications; or unidentified exogenous factors. The maturation index was found to be significantly associated with the following prognostic factors: weight relative to height, tumor size and estrogen receptor content of the primary tumor. These findings indicate that vaginal smear cytology may define specific subsets within menstrual categories which may be relevant to therapy and prognosis in breast cancer.
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PMID:Association of vaginal smear cytology with menstrual status in breast cancer. 402 97

Specific estrogen receptor activity (ER) was found in 115 of 175 (66%) tumors of patients treated for primary breast cancer in the period 1974-1981; 60 patients had ER-negative tumors. All patients were under observation for at least 48 months (median 76 months). The 24 patients who received adjuvant chemotherapy as part of their initial treatment, were excluded from the analysis of the disease-free interval (DFI). Groups of patients with ER-positive or ER-negative tumors did not differ significantly in clinical characteristics. Patients with ER-positive tumors had a significantly longer DFI than those with ER-negative tumors only in the first year after initial treatment. After prolonged observation a significant difference in recurrence rates was no longer found. In premenopausal women, the DFI was not different for those with ER-positive compared to those with ER-negative tumors, not even in the first year of observation. However, in postmenopausal women, those with ER-positive tumors had a significantly longer DFI up to 3 years after initial treatment but not thereafter. There was no difference in DFI between the ER-positive and ER-negative groups when the tumor stage was taken into account. It is concluded that the ER status of the primary tumor affects prognosis only on the short term.
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PMID:Disease-free interval and estrogen receptor activity in tumor tissue of patients with primary breast cancer: analysis after long-term follow-up. 405 39

Correlations have been found between certain pathologic features and estrogen and progesterone receptors status of mammary carcinoma. Well-differentiated carcinomas were more frequently receptor positive than poorly differentiated tumors. An increasing degree of lymphocytic and plasmacytic infiltrate in the tumor was associated with a decreasing incidence of estrogen receptor activity. In addition, elastosis in primary carcinomas has been correlated with response to endocrine therapy in patients with advanced disease. With increasing amounts of elastosis in the primary tumor, there was an increase in the response rate. Also, patients with estrogen receptor positive tumors with no elastosis showed a response rate similar to that of estrogen receptor-negative tumors. Hormone receptor analysis is most valuable when considered with other factors.
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PMID:Correlation of hormone receptors with pathological features in human breast cancer. 625 55

Knowledge of the steroid receptor content of human breast cancer is important for proper diagnosis and for deciding the proper treatment for metastatic disease. Few patients whose breast cancers lack estrogen receptor will benefit from endocrine therapy, while more than half of patients with estrophilin-rich cancers will obtain objective remissions. The probability of objective response to endocrine therapy increases with an increase in the quantity of estrogen receptor in the cancer. Furthermore, patients whose cancers have both estrogen and progestin receptors have a better probability of response than patients whose lesions have only one of the receptors present, although even in such cases the response rate is higher than that seen in patients whose tumors lack both receptors. The data currently available suggest that receptor assays carried out on the primary tumor can be used for prediction of subsequent response to endocrine therapy, even at a later time of recurrent disease. Nonetheless, while sequential assays of receptors in lesions from the same patients are likely to be in agreement, when changes occur they tend to be reductions in amount of receptor or loss of receptor during disease progression . Breast cancer patients with receptor-positive tumors appear to have longer disease-free intervals and prolonged survival when compared with patients whose cancers lack ER, but clearly a part of the prolonged survival relates to response to endocrine therapies. Receptor positivity is frequently associated with well-differentiated tumors, while more poorly differentiated cancers, as well as medullary tumors, in general, and possibly cancers with significant lymphocytic infiltration, are more likely to be receptor negative. While there are some problems reproducing the exact quantitative receptor results among various laboratories assaying the same breast cancer, standard biochemical assays are still the only clinically proven and generally accepted procedure for assessing receptor status of a tumor. Histochemical assays based both on the steroid content of a tumor or using steroid-protein fluorescein complexes, while showing some correlation with standard biochemical assays for estrogen receptor, do not appear to detect receptor protein itself and can not be used instead of standard receptor assays. With the recent availability of monoclonal antibodies to the estrogen receptor, newer assays based on immunochemical procedures are under development and can be expected to provide simpler, less expensive, and more useful biochemical as well as immunohistochemical methods for receptor determination.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Steroid receptors in breast cancer. 637 47

Between July 1975 and June 1979, 194 patients with State II or III breast carcinoma were randomized to receive either L-phenylalanine mustard (L-PAM), cyclophosphamide and 5-fluorouracil and prednisolone (CFP), or CFP and BCG. Sixty-one patients have recurred despite the adjuvant chemoimmunotherapy trial. Fifty-three are evaluable for survival and 36 for response to chemo-hormonal therapy. Those treated with a chemo-hormonal regimen for their first recurrence exhibited a 53% objective response rate to cytotoxic therapy or a 35% response to hormonal therapy. Prior exposure to L-PAM, cyclophosphamide, or 5-fluorouracil did not preclude response to "salvage" therapy regimens containing those agents. Neither menopausal status, estrogen receptor content, size of the primary tumor, adjuvant treatment, nor extent of the recurrence had any effect on subsequent survival. Overall, the entire group exhibited median survival of 37 months from initial diagnosis and 13 months from recurrence. Unlike recurrent Hodgkin's disease, there was no demonstrable relationship between the length of the disease-free interval and the likelihood of subsequent response to cytotoxic or hormonal treatment. Comparison is made to the results of "salvage" therapy administered after three other large adjuvant treatment series.
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PMID:Treatment of breast carcinoma recurrent after adjuvant chemoimmunotherapy. 638 84

Using a novel flow cytometric method to analyze paraffin-embedded archival material, cellular DNA content of the primary tumor was measured in 165 patients with Stage II breast cancer who had been entered onto a large, multicenter trial of adjuvant chemotherapy. Fifty-three (32%) of the tumors examined were diploid, and the remainder contained one or more aneuploid clones. Aneuploid tumors had more extensive axillary lymph node involvement (p less than 0.05 using chi 2 analysis), but there were no significant correlations between cellular DNA content and either menopausal or estrogen receptor status. Forty-nine of 112 (44%) patients with aneuploid tumors have relapsed, compared to 12 of 53 (23%) with diploid tumors, and relapse-free survival curves show that beyond 2 years the diploid group reaches an apparent plateau, with a projected 4-year relapse-free survival of 72%, whereas the aneuploid group shows a continuing risk of relapse with only 43% remaining relapse free at 4 years. This correlation was most pronounced in the premenopausal patients; only 5 of 36 (14%) of those with diploid tumors have relapsed compared to 23 of 63 (37%) in the aneuploid group. However, multivariate analysis using a stepwise Cox model does not thus far confirm an independent prognostic significance of cellular DNA content on disease-free survival compared to node status. The cellular DNA content of the primary tumor did not appear to influence the patients' survival following relapse. These results indicate that compared to aneuploid tumors either diploid tumors have a different natural history or they are more responsive to adjuvant chemotherapy, possibly due to a lower probability of their developing drug resistance.
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PMID:Influence of cellular DNA content on disease-free survival of Stage II breast cancer patients. 648 93

The relationships between estrogen receptor, progesterone receptor, and a variety of patient characteristics are described for 2,977 women with primary breast cancer. Older women were more likely to be estrogen-receptor positive than younger women. When patient age and menopausal status were analyzed together, age was found to be the primary determinant of increased estrogen-receptor concentrations. There appeared to be no relationship with progesterone receptor for either age or menopausal status when these variables were analyzed separately. But premenopausal women had higher progesterone receptor concentrations than postmenopausal women when patients of the same age were compared, perhaps reflecting greater estrogen-mediated synthesis of progesterone receptor. Tumor size was negatively related to steroid receptor concentrations, but no relationships were observed between steroid receptors and either the number of positive axillary lymph nodes or the location of the primary tumor.
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PMID:Correlations between estrogen receptor, progesterone receptor, and patient characteristics in human breast cancer. 649 96


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