PARIS, France--University of Chicago researchers have discovered
that the combination of a molecular marker of tumor virulence
and a marker of metastatic potential can be used to reliably predict
outcome in women with node-negative breast cancer, Ruth Heimann,
MD, PhD, reported at the annual meeting of the American Radium
"Scoring tumor microvascular density adds significant prognostic
information in addition to tumor size, nuclear grade, and estrogen-receptor
(ER) status," Dr. Heimann said.
From a database of 826 node-negative mastectomy patients, few
of whom had received adjuvant chemotherapy, Dr. Heimann and her
colleagues were able to retrieve archival material on 184 women
with mostly small tumors.
They chose ER status as an indicator of virulence, or the pace
of tumor growth, and used microvascular density, assessed with
factor VIII antibody, as a marker for metastagenicity, or the
ultimate likelihood of distant metastases.
Although in postmenopausal women, ER status had no impact on 20-year
disease-free survival, premenopausal women who were ER positive
did significantly worse than their receptor-negative counterparts,
Dr. Heimann noted.
She hypothesized that these apparently paradoxical results might
be attributable to the maturity of the database, pointing out
that the same phenomenon has been documented at Sloan-Kettering.
"When we looked at disease-free survival based on microvessel
density, we identified a group of patients with low microvessel
density who had significantly better long-term disease-free survival
than those with high microvessel density," Dr. Heimann said.
She emphasized that the favorable prognostic weight of low microvascular
density held for women with ER-positive tumors as well as for
those with nuclear grade 2 or 3 tumors.