Prognostic indices predictive of short-term disease-free survival of breast carcinoma patients receiving primary surgical treatment in Sri Lanka.
Background
Breast carcinoma (BCa) is the commonest malignancy among women worldwide and in Sri Lanka. Several prognostic indices are described for BCa.


Aims
To assess clinicopathological features and prognostic indices derived from routine clinical, histopathological and immunohistochemical (IHC) data, in a cohort of patients undergoing primary surgery for BCa and to determine their prognostic impact on short-term disease free survival.


Setting and Design
: This is a bidirectional cohort study of 208 women undergoing primary surgery for BCa at the National Hospital of Sri Lanka, from 2012-2014, excluding post-neoadjuvant chemotherapy cases.


Material and Methods
Clinical details, tumor size and nodal status were obtained from histopathology reports. Histopathology and estrogen/progesterone receptor and HER2 status were reviewed. Molecular subtype based on IHC was determined. Nodal ratio (number of positive nodes/total number retrieved) and Nottingham prognostic index were calculated. Follow up information was obtained by patient interviews and record review.


Statistical Analysis
Data was analyzed by univariate and multivariate Cox regression using SPSS19.0.


Results
Mean follow-up duration was 27.16 months (0.5-52 months, s = 9.35 months). 174 (82.9%) remained disease free with 19 (9%) deaths. Thirteen (6.2%) survived with metastasis and 4 (1.9%) with recurrences. On univariate Cox regression, tumor, nodal and TNM stages, nodal ratio and lymphovascular invasion (LVI) were predictive of disease free survival (DFS) (P = 0.001, P = 0.021, P = 0.022, P = 0.002, P = 0.018). On multivariate analysis TNM stage and LVI were predictive of DFS.


Conclusion
TNM stage and LVI were the most important predictors of short-term disease free survival in this study population, confirming that early detection of BCa at a lower stage has a significant impact on short-term outcomes.
['Wijesinghe|Harshima Disvini|HD|', 'Thuvarakan|Poobalasingham|P|', 'Samarasekera|Anandi|A|', 'S Lokuhetty|Menaka Dilani|MD|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001943:Breast Neoplasms D015331:Cohort Studies D018572:Disease-Free Survival D005260:Female D006801:Humans D008875:Middle Aged D009367:Neoplasm Staging D011379:Prognosis D016016:Proportional Hazards Models
prognostic indices Breast carcinoma Sri Lanka short-term survival