NATURAL-HISTORY OF NODE-NEGATIVE BREAST-CANCER - A STUDY OF 826 PATIENTS WITH LONG-TERM FOLLOW-UP

Purpose: We were interested in examining the longterm outcome of patients with node-negative breast cancer to address the following questions: (1) Is node-negative breast cancer a disease that is curable by local modalities? (2) Are there predictors of disseminated disease in node-negative breast cancer? (3) Are there subgroups of tumors that have different times to recurrence? Methods: From 1927 to 1984, 826 women with node-negative breast cancer were treated at the University of Chicago. patients underwent either a radical or extended radical mastectomy (83%) or a modified radical mastectomy (13%). Results: Follow-up evaluation ranged from 9 to 523 months (43.6 years); the mean follow-up period of survivors is 162 months (13.5 years). On multivariate analysis, the strongest predictor of outcome and time to relapse was pathologic tumor size. Patients with tumors less than 2 cm had a 20-year disease free survival (DFS) rate of 79% and a median time to recurrence of 48 months as compared with patients with tumors greater than 2 cm, who had a survival rate of 64% (P < .001) and a median time to recurrence of 37 months (P = .01). Conclusion: With extended follow-up evaluation, node-negative breast cancer is a curable disease. Size is the strongest predictor of dissemination and rate of relapse. These delta suggest that given the natural history of node-negative breast cancer, analysis of clinical trials with short follow-up periods can be misleading, since it may identify those patients whose tumors have a greater virulence but not necessarily a greater likelihood to metastasize. (C) 1995 by American Society of Clinical Oncology.