Further observations on prognostic factors in cancer of the female breast

A series of nearly 900 Norwegian women with cancer of the breast provides further evidence of the prognostic significance of the structural characteristics of the tumor and the lymph nodes, e.g., nuclear grade and sinus histiocytosis. The percentage of patients with evidence of a histiocytic reaction in the lymph nodes was found to depend on the number of nodes examined. Among patients with at least 6 nodes available for review, one third exhibited a histiocytic reaction. In the group in which 6 or more nodes were examined, the percentage of nodes with metastases is a powerful prognostic factor. In the presence of at least one favorable factor, such as a small tumor, histiocytic reaction in the nodes, or favorable nuclear grade, the survival of patients with metastases in less than one third of the axillary nodes is similar to survival of patients with no nodal metastases. The relationship of histologic type to other structural characteristics was investigated. Mucinous tumors had a high percentage with favorable nuclear grade. Medullary tumors had a high percentage with unfavorable nuclear grade, but the influence of this factor on survival was counterbalanced by the presence of lymphoid infiltrate in the tumor. The findings in this study suggest that more intensive study of the dynamic interactions between cancer and the lymphoicticulocndothelial system will provide insight into the behavior of human cancer.