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Breast malignant, males, children

Breast cancer

Prognostic factors - General

Reviewer: Monika Roychowdhury, M.D. (see Reviewers page)
Revised: 10 November 2012, last major update February 2012
Copyright: (c) 2001-2012, PathologyOutlines.com, Inc.

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 Ki-67 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)

End of Breast malignant, males, children > Breast cancer > Prognostic factors - General

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