Separating favorable from unfavorable prognostic markers in @entity0 : the role of XXXX .

@entity1 @entity0 @entity7499 @entity5 @entity5962 @entity18962
Distant metastases are the major cause of morbidity and mortality in @entity1 with @entity0 . The ability to predict the metastatic proclivity is essential in choosing the optimal treatment. @entity5 size and grade, which are frequently used markers in node-negative @entity0 @entity1 , are inadequate markers for prognosis and individualized treatment design. The steps in metastatic progression include @entity7499 , invasion, and changes in adhesion characteristics. We developed a strategy for choosing biomarkers representing these steps in malignant progression to identify @entity1 with occult metastases who will need chemotherapy and spare those @entity1 whose @entity5 have not developed the capacity to spread. To evaluate the added significance of @entity5962 to that of @entity18962 and @entity7499 in determining metastatic proclivity, we used archival material from 168 node-negative @entity0 @entity1 who were treated with mastectomy without any adjuvant chemotherapy or hormone therapy. Immunohistochemistry was used to detect @entity5962 and @entity18962 expression, whereas @entity7499 was determined by microvessel count (MVC) after immunohistochemical staining. The median follow-up is 14 years. We found that @entity5962 is better in identifying the poor prognosis @entity1 . The 14-year disease-free survival (DFS) is 84%, 80%, and 56% in @entity1 with high, intermediate, and low @entity5962 . The worst prognosis group using @entity18962 and MVC as biomarkers has a 14-year DFS of 62%. In this group, if @entity5962 is low, the 14-year DFS is further decreased to 44%. @entity18962 and MVC are better in identifying the good prognosis @entity1 . The long-term DFS is >90% if MVC is low or if @entity18962 is high. Multivariate analysis shows that @entity5962 , @entity18962 , and MVC are more significant prognostic biomarkers than @entity5 size or grade. Loss of @entity5962 appears to be a latter step in the metastatic progression compared to @entity7499 and the loss of @entity18962 expression.
