SUMMARY BACKGROUND DATA: The purpose of this study was to determine the type of relationship between tumor size and mortality in early breast carcinoma. METHODS: The data was abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results Program of women diagnosed with primary breast carcinoma between 1988 and 1997 presenting with a T1-T2 lesion and no metastasis in whom axillary node dissection was performed: 58,070 women were node-negative (N0) and 25,616 were node-positive (N+). End point was death from any cause. Tumor size was modeled as a continuous variable by proportional hazards using a generalized additive models procedure. RESULTS: Functionally, a Gompertzian expression exp(-exp(-(size-15)/10)) provided a good fit to the effect of tumor size (in millimeters) on mortality, irrespective of nodal status. Quantitatively, for tumor size between 3 and 50 mm, the increase of crude cumulative death rate (number of observed deaths divided by the number of patients at risk) increased with size from 10% to 25% for N0 and from 20% to 40% for N+. CONCLUSIONS: The functional relationship of tumor size with mortality is concordant with current knowledge of tumor growth. However, its qualitative and quantitative independence of nodal status is in contradiction with the prevailing concept of sequential disease progression from primary tumor to regional nodes. This argues against the perception that nodal metastases are caused by the primary tumor.
SUMMARY BACKGROUND DATA: The purpose of this study was to determine the type of relationship between tumor size and mortality in early breast carcinoma. METHODS: The data was abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results Program of women diagnosed with primary breast carcinoma between 1988 and 1997 presenting with a T1-T2 lesion and no metastasis in whom axillary node dissection was performed: 58,070 women were node-negative (N0) and 25,616 were node-positive (N+). End point was death from any cause. Tumor size was modeled as a continuous variable by proportional hazards using a generalized additive models procedure. RESULTS: Functionally, a Gompertzian expression exp(-exp(-(size-15)/10)) provided a good fit to the effect of tumor size (in millimeters) on mortality, irrespective of nodal status. Quantitatively, for tumor size between 3 and 50 mm, the increase of crude cumulative death rate (number of observed deaths divided by the number of patients at risk) increased with size from 10% to 25% for N0 and from 20% to 40% for N+. CONCLUSIONS: The functional relationship of tumor size with mortality is concordant with current knowledge of tumor growth. However, its qualitative and quantitative independence of nodal status is in contradiction with the prevailing concept of sequential disease progression from primary tumor to regional nodes. This argues against the perception that nodal metastases are caused by the primary tumor.
Authors: W Jonat; M Kaufmann; W Sauerbrei; R Blamey; J Cuzick; M Namer; I Fogelman; J C de Haes; A de Matteis; A Stewart; W Eiermann; I Szakolczai; M Palmer; M Schumacher; M Geberth; B Lisboa Journal: J Clin Oncol Date: 2002-12-15 Impact factor: 44.544
Authors: P L Fitzgibbons; D L Page; D Weaver; A D Thor; D C Allred; G M Clark; S G Ruby; F O'Malley; J F Simpson; J L Connolly; D F Hayes; S B Edge; A Lichter; S J Schnitt Journal: Arch Pathol Lab Med Date: 2000-07 Impact factor: 5.534
Authors: Vincent Vinh-Hung; Pauline T Truong; Wolfgang Janni; Nam Phong Nguyen; Georges Vlastos; Gábor Cserni; Melanie E Royce; Wendy A Woodward; Donald Promish; Patricia Tai; Guy Soete; Sabine Balmer-Majno; Bruno Cutuli; Guy Storme; Christine Bouchardy Journal: Strahlenther Onkol Date: 2009-03-28 Impact factor: 3.621
Authors: Manjulata Singh; Shilpaa Mukundan; Maria Jaramillo; Steffi Oesterreich; Shilpa Sant Journal: Cancer Res Date: 2016-05-23 Impact factor: 12.701
Authors: Monika Nothacker; Volker Duda; Markus Hahn; Mathias Warm; Friedrich Degenhardt; Helmut Madjar; Susanne Weinbrenner; Ute-Susann Albert Journal: BMC Cancer Date: 2009-09-20 Impact factor: 4.430