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Histologic grade is well recognized for its prognostic significance in cases of primary operable invasive breast carcinoma; however, the majority of studies in which grade has been assessed have been based on single-center trials. In addition, the role of grade in predicting response to chemotherapy has not been examined in many previous studies.The authors assessed the value of Nottingham histologic grade (NHG) in a group of 465 patients enrolled in a multicenter, randomized International Breast Cancer Study Group clinical trial of adjuvant chemotherapy for patients with lymph node (LN) positive and LN negative primary breast carcinoma (formerly named Ludwig Trial V).NHG was a predictor of overall survival for both LN negative and LN positive patients (P=0.045 and P0.001, respectively). NHG was associated with a poorer prognosis for both LN positive and LN negative patients, with hazard ratios of 1.651 (P0.001) and 1.437 (P=0.045), respectively, for an increase of one grade. Among LN negative patients, this survival disadvantage was observed only for those who received perioperative chemotherapy. For LN positive patients, an increase of one grade resulted in a significant overall survival disadvantage regardless of whether prolonged or perioperative chemotherapy was given. For LN negative patients grouped by grade, there was no observed difference in overall or disease free survival according to whether perioperative chemotherapy or no adjuvant therapy was given. However, LN positive patients with Grade 3 tumors had a significantly greater overall and disease free survival benefit from prolonged chemotherapy than from perioperative chemotherapy (P=0.016 and P=0.013, respectively); LN positive patients with Grade 1 or 2 disease in both treatment arms had comparable overall and disease free survival. A strong correlation between the previously utilized Bloom-Richardson grading system (BRG) and NHG was observed (P0.001 and kappa=82%) and no apparent differences in overall and disease free survival were observed between the two systems. NHG did, however, identify a greater proportion of tumors as Grade 1, and BRG identified a greater proportion of breast carcinomas as Grade 3.This multicenter clinical study confirms the value of histologic grade, and the authors propose that this technique be used to identify Grade 3, LN positive patients who will benefit from prolonged rather than perioperative chemotherapy.

The expression of Le(y) (Lewis(y) Hapten), a difucosylated type 2 blood group-related antigen, in colorectal lesions was studied by using the monoclonal antibody C14. In normal colonic mucosa, strong staining has been observed in the terminal ileum, cecum, and ascending colon with minimal staining in the rest of the colon and rectum. Eighty-three percent of adenomas expressed Le(y), with 70% showing an increased expression of Le(y) compared with normal tissue. Only 25% of metaplastic (nonneoplastic) polyps showed an increased expression of Le(y). The expression of Le(y) in adenomas was correlated with both size and degree of epithelial dysplasia of the adenomas and also showed an association with histologic type. No correlation was found with the location and morphology of the adenomas. The most strongly related parameter was the degree of dysplasia. All adenomas with severe dysplasia showed increased expression of Le(y), with 83% showing marked expression. This finding was irrespective of their size or type. Adenomas which did not exhibit severe dysplasia showed increased expression in 66% of cases, but only 18% showed marked expression. These findings show that the expression of Le(y) in colorectal lesions is associated with features related to malignant potential. Le(y) expression may provide useful prognostic information in the assessment of colorectal polyps.

One hundred patients were entered in a randomized, controlled study of adjuvant tamoxifen therapy in gastric carcinoma. Estrogen receptor status was established by an immunohistologic method (ERD5) and 55.8% of the tumors were positive. Tamoxifen had no overall effect on survival, but there was a significant decrease in the survival time of the patients with ERD5-positive tumors. Estrogen receptor status (by the ERD5 method) is an independent prognostic factor in gastric cancer. Tamoxifen therapy does not prolong survival, and new therapeutic strategies require investigation.