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Model for Breast Cancer Survival: Relative Prognostic Roles of Axillary Nodal Status, TNM Stage, Estrogen Receptor Concentration, and Tumor Necrosis¹

Department of Pathology, The University of British Columbia and Vancouver General Hospital, Vancouver, British Columbia, Canada V5Z 1M9

The independent prognostic effects of certain clinical and pathological variables measured at the time of primary diagnosis were assessed with Cox multivariate regression analysis. The 859 patients with primary breast cancer, on which the proportional hazards model was based, had a median follow-up of 60 months. Axillary nodal status (categorized as N₀,N_1–3 or N₄₊) was the most significant and independent factor in overall survival, but inclusion of TNM stage, estrogen receptor (ER) concentration and tumor necrosis significantly improved survival predictions. Predictions made with the model showed striking subset survival differences within stage: 5-year survival from 36% (N₄₊, log[ER] = 0, marked necrosis) to 96% (N₀, log₀[ER] = 6, no necrosis) in TNM I, and from 0 to 70% for the same categories in TNM IV. Results of the model were used to classify patients into four distinct risk groups according to a derived hazard index. An 8-fold variation in survival was seen with the highest (>3) to lowest index values (<1). Each hazard index level included patients with varied combinations of the above factors, but could be considered to denote the same degree of risk of breast cancer mortality. A model with ER concentration, nodal status, and tumor necrosis was found to best predict survival after disease recurrence in 369 patients, thus confirming the enduring biological significance of these factors.

¹ This research was supported by grants from the British Columbia Health Care Research Foundation and the British Columbia Cancer Foundation.

² To whom requests for reprints should be addressed.

Received 1/29/88. Revised 5/27/88. Accepted 7/ 1/88.

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