Comparison of long-term survival of 1986 consecutive patients with breast cancer treated at the National Cancer Institute of Milano, Italy (1971 to 1972 and 1977 to 1978)
Article Abstract:
Often, the effectiveness of cancer treatments is evaluated not on the basis of controlled studies but rather on the basis of comparison with the apparent ''average'' survival as determined by surveying published articles in the medical literature. Since different institutions often serve different groups of patients, such comparisons are not always appropriate. To determine whether increasing knowledge about breast cancer has resulted in improved treatment, 1,077 cases treated from 1977 to 1978 were compared with 909 cases treated at the same institution between 1971 and 1972. The overall survival of breast cancer patients improved in the interval between these two times. The 10-year survival rate during the earlier period was 59.4 percent, while for the later period the 10-year survival of patients was 65 percent, a significant difference. The difference is not attributable merely to improvements in early detection; indeed, patients with breast cancers larger than 2 centimeters had significantly better survival in the later years. Patients with cancers smaller than 2 centimeters experienced a small increase in 10-year survival from 67.6 percent to 71.5 percent, but this difference did not achieve statistical significance. The improvement in 10-year survival for patients with cancers between 2 and 5 centimeters was greater; the survival rate rose from 45.6 percent to 58.2 percent in this group. Similar observations were made for patients whose cancer had already spread to the lymph nodes of the armpit (axillary nodes). The 10-year survival rate for patients with no signs of cancer in their lymph nodes rose from 71.6 percent to 78.4 percent over the study interval. Likewise, patients with positive lymph nodes, who are at a much higher risk of recurrence, experienced an improvement in 10-year survival from 47.3 percent to 53.2 percent. The results confirm an improvement in survival of breast cancer patients which is directly attributable to improvements in the management of the disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Prognostic factors in cystosarcoma phyllodes: a clinicopathologic study of 77 patients
Article Abstract:
Cystosarcoma phyllodes is a type of breast cancer; it is relatively uncommon compared with other breast cancers, accounting for only 0.3 to 0.9 percent of breast cancers. A study was conducted to determine the factors which predict the likely survival of patients with this form of breast cancer. A total of 77 cases were identified for which satisfactory diagnostic information and case records were available. The average age at diagnosis was 50 years, and in no case were metastatic tumors found at the time of the original diagnosis. However, 16 of these patients ultimately developed metastatic disease and died of cystosarcoma phyllodes. As might be expected, local recurrence in the breast was more common among the patients who received breast-conserving surgery than among those who underwent mastectomy. However, this did not influence the likelihood of distant metastases and neither overall survival or metastasis-free survival was affected by the type of surgery. Statistical analysis of the case characteristics identified only one feature which was significantly associated with increased risk of death. This feature is tumor necrosis, or areas of dead tissue within the tumor. This feature was associated with a more than fourfold increase in the risk of death, but only seven patients had tumor necrosis, and so this feature is unlikely to be particularly useful in predicting case outcome. Of the 77 patients, 21 percent died of cystosarcoma phyllodes and 23 percent died of unrelated causes without signs of cystosarcoma. The remaining 56 percent of the patients remain alive with no evidence of disease. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1991
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Surgical treatment of phyllodes tumor of the breast
Article Abstract:
Phyllodes tumor is a tumor of mixed composition which unfortunately has been referenced in at least 62 different ways in the medical literature. The term 'phyllodes tumor' is the World Health Organization's preferred nomenclature and describes a tumor that accounts for between 0.3 and 0.9 percent of all breast tumors. Some controversy exists on the best surgical management of these tumors. After an evaluation of 81 cases of phyllodes tumor of the breast, surgically treated between 1974 and 1983 (71 of whom were available for follow-up), some recommendations may be made. The histological (microscopic tissue structure) appearance of this tumor is not useful for prognosis. Benign tumors may be identified on the basis of tumor margin; a sharp margin is a good prognostic indicator, whereas infiltrate margins and high number of mitoses (cell divisions) suggests a risk of recurrence or metastatic spread. Of the 24 patients with benign phyllodes tumors, only one had a local recurrence. Among 26 women with borderline tumors, 10 local recurrences and one distant metastasis was observed. A greater proportion of women with malignant phyllodes tumors were treated by mastectomy; three local recurrences and one metastasis occurred among these 21 patients. Local recurrences did not affect survival; only the patients with metastases died, suggesting that wide resection is the surgical treatment of choice. Mastectomy may be reserved for very large tumors and for local recurrences of tumors should they occur. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Cancer
Subject: Health
ISSN: 0008-543X
Year: 1989
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