Schumacher M, Schmoor C, Sauerbrei W, Schauer A, Ummenhofer L, Gatzemeier W, Rauschecker H
Institute of Medical Biometry and Informatics, University of Freiburg, Germany.
Breast Cancer Res Treat. 1993;25(3):235-45. doi: 10.1007/BF00689838.
The prognostic effect of histological tumor grade was evaluated in 1036 patients with early breast cancer (pT1 pN0 M0) entered into a trial comparing mastectomy and breast preserving treatment. All analyses were adjusted for the factors treatment, patients' age, and tumor size. Tumor grade was defined according to Bloom and Richardson based on the sum of scores assigned to each of three histological features: 1) degree of differentiation, 2) pleomorphism, and 3) mitotic index. The relative importance of these factors with regard to disease-free survival was evaluated. In univariate as well as in multivariate analyses the pleomorphism was the only factor showing a significant effect (univariate: p = 0.0024, multivariate: p = 0.015). It was investigated how the factors should be combined to define a histological grading score which yields the best possible classification of the patients with respect to prognosis. A new grading system was defined splitting the patients into three groups: 1) pleomorphism 1; 2) pleomorphism 2 or pleomorphism 3 and mitotic index 1; 3) pleomorphism 3 and mitotic index 2 or 3. This yields a good classification of the patients with respect to prognosis (p = 0.0004). The prognostic effect of this score was compared with the effects of the grading systems proposed in the literature. According to Bloom and Richardson and in the modified version by Schauer and Weiss, grading is based on the sum of scores of the various histological factors. Therefore, the strong effect of the pleomorphism was diluted in these grading definitions (Bloom and Richardson: p = 0.03, Schauer and Weiss: p = 0.028). The grading system proposed by Le Doussal et al. consists only of the scores of pleomorphism and mitotic index (p = 0.014). In summary, the factor pleomorphism showed a stronger effect on disease-free survival by itself than the grading systems proposed in the literature.
在一项比较乳房切除术和保乳治疗的试验中，对1036例早期乳腺癌（pT1 pN0 M0）患者评估了组织学肿瘤分级的预后影响。所有分析均针对治疗、患者年龄和肿瘤大小等因素进行了调整。肿瘤分级根据Bloom和Richardson方法定义，基于对三个组织学特征分别赋予的分数总和：1）分化程度；2）多形性；3）有丝分裂指数。评估了这些因素对无病生存期的相对重要性。在单变量和多变量分析中，多形性是唯一显示出显著影响的因素（单变量：p = 0.0024，多变量：p = 0.015）。研究了如何组合这些因素以定义一个组织学分级分数，从而在预后方面对患者进行尽可能最佳的分类。定义了一种新的分级系统，将患者分为三组：1）多形性1级；2）多形性2级或多形性3级且有丝分裂指数1级；3）多形性3级且有丝分裂指数2级或3级。这在预后方面对患者进行了良好的分类（p = 0.0004）。将该分数的预后影响与文献中提出的分级系统的影响进行了比较。根据Bloom和Richardson以及Schauer和Weiss的修改版本，分级基于各种组织学因素的分数总和。因此，在这些分级定义中，多形性的强烈影响被稀释了（Bloom和Richardson：p = 0.03，Schauer和Weiss：p = 0.028）。Le Doussal等人提出的分级系统仅由多形性和有丝分裂指数的分数组成（p = 0.014）。总之，多形性因素本身对无病生存期的影响比文献中提出的分级系统更强。
