Pathology Outlines - Prognostic factors

Breast malignant, males, children
Breast cancer
Prognostic factors - General

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 20 October 2016, last major update February 2012

Copyright: (c) 2002-2016, PathologyOutlines.com, Inc.

PubMed Search: Prognostic factors [title] breast cancer

Table of Contents

Prognostic factors

Cite this page: Prognostic factors - General. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/breastmalignantprognosis.html. Accessed July 14th, 2017.

Prognostic factors

Assess future outcome, such as survival
See also prognostic factors for particular tumor subtypes

Negative prognostic factors

Classic factors:
- High stage (defined by tumor size, nodal and distant metastases, including possibly nodal micrometastases, Ann Surg Oncol 2007;14:3378)
- High histologic grade (J Clin Oncol 2008;26:3153, Histopathology 1991;19:403)
- Younger age
- Skin invasion
- Nipple invasion
- Angiolymphatic invasion
- Fibrotic focus
- HER2 (cERBB2) expression
- Value of traditional prognostic factors persists for assessing survival at 10+ years (Breast Cancer Res Treat 2008;107:309)
Negative prognostic factors that are less commonly accepted / used:
- Matrix metalloproteinase-1 (MMP1) expression in tumor and stromal cells (BMC Cancer 2011 Aug 11;11:348)
- Increased Ki67 positivity
- Retraction artifact mimicking angiolymphatic invasion (Am J Surg Pathol 2007;31:129)
- Infiltrative margins versus pushing margins
- Local recurrence
- bcl2 negativity (Clin Cancer Res 2006;12:2468, BMC Cancer 2008;8:153)
- p53 mutation or HER2+ (Acta Oncol 2008;47:618)
- Phosphohistone H3 >= 13 (Mod Pathol 2007;20:1307)
- Disseminated tumor cells to bone marrow (Clin Cancer Res 2008;14:3306)
- Tumor detection by symptoms versus screening (Cancer Epidemiol Biomarkers Prev 2008;17:1096)
- In women with metastatic disease: age at initial diagnosis, hormonal receptor status and site of metastasis (Ann Oncol 2008;19:2012)
- S phase fraction may have prognostic value for fine needle aspirates (Cytopathology 2008;19:294); otherwise ploidy and S phase fraction appear to NOT have prognostic value (Arch Pathol Lab Med 2001;125:364)

Favorable histology types

Tubular, cribriform, medullary, colloid, papillary, adenoid cystic and secretory/juvenile
Unfavorable types are signet ring, basal-like and inflammatory

Nottingham Prognostic Index

Based on tumor size, stage and grade (Breast Cancer Res Treat 1992;22:207, Pathol Oncol Res 2008;14:113, table 1, table 2)

Predictive factors

Assess response to treatment, such as ER and PR (response to anti-estrogens) or HER2 (response to anti-HER2 treatment)