The current findings completely affirm the validity of our original observations indicating the appropriateness of grouping primary breast cancer patients into those with negative, 1 to 3, or greater than or equal to 4 positive nodes. Results, however, reveal that there is a risk in combining all patients with greater than or equal to 4 positive nodes into a single group. Since there was a 25% greater disease-free survival and an 18% greater survival in those with 4 to 6 than in those with greater than or equal to 13 positive axillary nodes, such a unification may provide misleading information regarding patient prognosis, as well as the worth of a therapeutic regimen when compared with another from a putatively similar patient population. Of particular interest were findings relating the conditional probability, i.e., the hazard rate, of a treatment failure or death each year during the 5-year period following operation to nodal involvement with tumor. Whereas the hazard rate for those with negative, or 1 to 3 positive nodes, was relatively low and constant, in those with greater than or equal to 4 positive nodes the risk in the early years was much greater, but by the fifth year it was similar to that occurring when 1-3 nodes were involved, and not much different from negative node patients. The same pattern existed whether 4 to 6 or greater than or equal to 13 nodes were positive. When the current findings are considered relative to other factors with predictive import, it is concluded that nodal status still remains the primary prognostic discriminant.

Relation of number of positive axillary nodes to the prognosis of patients with primary breast cancer. An NSABP update.

The estrogen receptor (ER) assay has become a standard practice in the management of advanced breast cancer. Tumors lacking ER respond infrequently to endocrine therapy, whereas response rates of 50 to 60 percent are observed in ER+ tumors. Recent studies indicate that the ER status of the primary tumor is a good predictor of the endocrine dependence of metastatic tumors at the time of clinical relapse. Furthermore, the absence of ER in the primary tumor is an important independent prognostic indicator of higher rate of recurrence and shorter survival. Quantitative analysis of Er and an assay for progesterone receptor (PgR) are two methods for increasing the accuracy of selecting or rejecting patients for hormonal therapy; tumors with a high quantitative ER content or those with a positive PgR display the highest objective response rates. Preliminary analysis suggests that the presence of PgR may be a better marker of tumor hormone dependence than quantitative ER.

The value of estrogen and progesterone receptors in the treatment of breast cancer

Purpose: To determine whether progesterone receptor (PgR) status provides additional value to estrogen receptor (ER) status and improves prediction of benefit from endocrine treatment among patients with primary breast cancer. Patients and Methods: Clinical outcomes of patients in two large databases were analyzed as a function of steroid receptor status. The first database (PP), contained 3,739 patients who did not receive any systemic adjuvant therapy and 1,688 patients who received adjuvant endocrine therapy but no chemotherapy. The second database (SPORE), contained 10,444 patients who received adjuvant endocrine therapy but no chemotherapy. Biochemical ER and PgR assays were identically performed in two different central laboratories. Results: In univariate and multivariate analyses, the prognostic significance of PgR status among systemically untreated patients is modest. Among endocrine-treated patients, however, multivariate analyses, including lymph-node involvement, tumor size, and age, demonstr...

Progesterone Receptor Status Significantly Improves Outcome Prediction Over Estrogen Receptor Status Alone for Adjuvant Endocrine Therapy in Two Large Breast Cancer Databases

Sections of formalin-fixed, paraffin-embedded tissue from 185 primary breast carcinomas were stained immunohistochemically using a polyclonal antibody against the c- erbB -2 oncoprotein. Positive staining, which is known to correlate with gene amplification, was associated with earlier relapse, shorter postrelapse survival, and shorter overall survival. Lymph node, epidermal growth factor receptor, and estrogen receptor status, tumor size, and histological grade also had prognostic significance but, applying multivariate analysis, only lymph node status was a more important predictor of relapse-free and overall survival than staining for the oncoprotein. Positive staining was correlated with negative estrogen receptor status and high histological grade, but there was no association with either lymph node or epidermal growth factor receptor status or tumor size. Expression of the c- erbB -2 oncoprotein appears to be an important independent indicator of prognosis in human breast cancer.

https://cancerres.aacrjournals.org/content/canres/49/8/2087.full.pdf

Expression of c-erbB-2 Oncoprotein: A Prognostic Indicator in Human Breast Cancer

Estrogen and progesterone receptors (ER and PR) have now been studied in clinical breast cancer for more than 20 years. Positive receptor status correlates with favorable prognostic features including a lower rate of cell proliferation and histologic evidence of tumor differentiation. During the first several years after diagnosis, patients with ER-positive tumors tend to have a lower recurrence rate; however, this is balanced by a higher recurrence rate in subsequent years so that the overall prognostic significance of receptor status is modest. ER and PR have their greatest utility in predicting response to hormonal therapy, both in the adjuvant setting and for advanced disease. When the assay is done properly and cut-offs for ER-negativity and positivity are defined by clinical studies of patients treated with endocrine therapy, receptor status is very helpful in identifying groups of patients who are very unlikely to benefit from hormonal therapy. Tumors that express both ER and PR have the greatest benefit from hormonal therapy, but those containing only ER or only PR still have significant responses.

Steroid hormone receptors in breast cancer management.

This study was designed to determine whether the estrogen receptor (ER) status of a primary breast cancer has prognostic value and how this information compares with the information gained from lymph node status at masectomy 335 primary breast carcinomas were tested for ER in tumor cytosol fractions Of the 335 177 contained ER and 158 contained no significant amounts of ER; the respective percentages of ER positive and negative tumors were 528 and 472 151 patients experienced carcinoma spread to the regional lymph nodes (484%) and 161 had no detectable metastases (516%) There was no connection between lymph node status and receptor status The ER status was correlated with disease-free interval survival and site of recurrent disease ER positive carcinomas had a longer disease-free interval longer survival (calculated from time of mastectomy to death) and longer time interval between recurrence and death Lymph node status at mastectomy also influenced these parameters ER positive cancers had significantly better chance of survival independent of lymph node status ERs also delayed recurrence in lymph-node-positive carcinomas; this advantage deteriorated with increasing time from operation ER positive or negative primary carcinomas showed no predilection for spread to any particular site however The significant differences in this report were P < 01

https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142%28197908%2944%3A2%3C671%3A%3AAID-CNCR2820440238%3E3.0.CO%3B2-V

Prognostic value of estrogen receptors in primary breast cancer.

—Software Requirements Prioritization is an important issue that has a more profound effect on the overall quality of software development. Application of software requirements prioritization provides benefits to minimize risks in software development so that the most important and most impactful requirements are given priority. This paper presents a proposed software requirements prioritization method named MCBRank, which incorporates renowned MoSCoW Method and Case-Based Ranking to improve prioritization correctness. It elaborates on the implementation of MCBRank in an empirical investigation to determine software requirements prioritization for a potential e-library system. The investigation allows the software requirements prioritization process to be implemented by using the proposed MCBRank method. A role-playing empirical investigation with 30 respondents prioritized 31 software requirements, and the results were measured by Cohen Kappa. The kappa results show that MCBRank achieves a better agreement towards the Gold Standard with kappa value of 0.60. Therefore, the investigation results support that MCBRank improves the importance of ranking correctness, representing the stakeholders’ wants and the organization's actual needs for the potential e-library system.

Terry Woodings

Papers

Prognostic value of estrogen receptors in primary breast cancer.

MCBRank Method to Improve Software Requirements Prioritization