Paper II — 2023 July (Supplementary) (2019 Scheme) — Q7

Paper II

2023 July (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Prognostic and predictive factors for breast carcinoma

Q78 marksShort Essays★✓

Answer

Prognostic factors predict overall outcome (survival), while predictive factors predict response to a specific therapy; several factors serve both roles in breast carcinoma.

Prognostic factors:

1. Tumour size — larger tumours carry worse prognosis.
2. Lymph node status — the single most important prognostic factor; number of involved axillary nodes correlates directly with recurrence risk and reduced survival.
3. Histologic grade (Nottingham/modified Bloom-Richardson grading — tubule formation, nuclear pleomorphism, mitotic count) — higher grade, worse prognosis.
4. Histologic type — e.g., tubular, mucinous, and papillary carcinomas have better prognosis than invasive ductal carcinoma (no special type) or invasive lobular carcinoma.
5. Lymphovascular invasion — presence indicates worse prognosis.
6. Stage (TNM) — combines size, nodal, and metastatic status; the single best overall prognostic indicator.
7. Proliferative rate (Ki-67 index) — higher proliferation, worse prognosis.
8. Patient age — younger age at diagnosis is generally associated with worse prognosis.

Predictive (and prognostic) factors:

1. ER/PR (Estrogen/Progesterone receptor) status — positivity predicts response to hormonal therapy (tamoxifen, aromatase inhibitors) and confers a better prognosis.
2. HER2/neu (c-erbB2) status — overexpression/amplification predicts response to anti-HER2 targeted therapy (trastuzumab) but is associated with a more aggressive phenotype/worse prognosis if untreated.
3. Molecular subtype (Luminal A, Luminal B, HER2-enriched, Basal-like/triple-negative) — derived from ER/PR/HER2/Ki-67 profile, guides both prognosis and treatment selection; triple-negative carries the worst prognosis.

These factors together (summarized in systems like Nottingham Prognostic Index) guide clinical staging, treatment planning, and counselling on outcome.

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