Rapid growth rate: a method of identifying node-negative breast cancer patients with a high risk of recurrence.

Overview

Among node-negative patients with localized breast cancer (TNM stages T1-3 N0-1 M0), the rate of disease progression, classified with a clinical method of assessment, was rapid in 12%. Prognosis was substantially worse in the rapid groups than in patients classified as slow or intermediate. For instance, the 10 yr disease free survival rate was 55 and 50% in the rapid groups compared with 71% in the intermediate and 82% in the slow groups. Additionally, among those who did develop recurrent disease, the disease-free interval was shortest in the most rapid group (10 months) and longest in the slow group (50 months). The distinctive prognostic gradients formed by the growth-rate strata persisted when differences in symptomatic state, histologic type, tumor size, menstrual status, age, and treatment were taken into account through the Cox proportional hazards model. The node-negative patients who were identified as rapid have had a high risk of recurrence, while those with slow growth rates had an excellent prognosis. The index could improve therapeutic efficacy in this subset of patients by identifying high risk patients in whom adjuvant therapies may do more good than harm.