Predictive and prognostic factors associated with survival outcomes in patients with stage I–III breast cancer: A report from a developing country


Professor Zeba Aziz, Allama Iqbal Medical College Medical Oncology, Allama Shabbir Ahmad Usmani Road Lahore Punjab 54590, Pakistan. Email:


Background:  There is a paucity of data on factors that predict relapse and survival for stages I to III breast cancer patients from developing countries. The primary purpose of our study is to correlate clinical outcomes with established prognostic and predictive factors in patients with stage I to III breast cancer.

Methods:  A total of 525 patients followed from January 1996 to December 2005 were analyzed for factors predicting relapse and mortality. These included their age, social strata, tumor size, number of positive lymph nodes, stage and histological grade, estrogen and progesterone receptor status and treatment profiles.

Results:  The patients' median age was 45 years. Only 6.7% patients presented with stage I disease. Factors that were predictive of relapse were a poor socioeconomic status P < 0.0001, T2/T3/T4 tumors P < 0.0001, N1/N2/N3 P < 0.0001, grade III P < 0.0001, initial stage II/III P < 0.0001, estrogen receptor negativity P 0.01. For overall survival significant predictive factors were poor socioeconomic status P < 0.009 T2/T3/T4 P < 0.0001, N1/N2/N3 P < 0.0001, grade III P < 0.001, initial stage II/III P < 0.0001, estrogen receptor (ER) negativity P < 0.002. Event free survival and overall survival for all patients at 5 and 10 years were 57 and 37%, and 72 and 61%, respectively.

Conclusion:  Poor prognostic markers for survival outcomes were large tumors, advanced disease, number of positive lymph nodes, grade III tumors, ER/progesterone receptor (PR) negative tumors, poor socioeconomic status and variable treatment profiles. Clinical outcomes and survival associated for each prognostic marker were inferior when compared to developed countries due to the larger tumor burden and less than optimal treatment. Early detection programs, improvements in technical expertise and quality of care, with economically feasible guidelines, need to be developed for countries with limited resources.