C.R. Freeman

A series of 1,467 Caucasian patients with non-disseminated lymphomas of extranodal origin was taken from data collected by the End Results Group of cancer registries in the years 1950-1964. Excluding Hodgkin's disease, about one fourth of the lymphomas reported arose in sites other than lymph nodes. Survival rates and distributions are listed for site of origin, major histologic types, sex, age, and extent of disease. For the more frequently reported sites, survival rates are given according to the type of initial treatment used. The prognosis of patients with extranodal lymphomas is compared with that for “all cancers” of the same site, and the lymphoma patients appear to fare appreciably better when the site of origin is stomach, lung, or tonsil.

The correlation of structural features in the tumor and the regional lymph nodes with patient survival is confirmed in a study of 600 Norwegian patients with gastric cancer. Follicular hyperplasia in the regional nodes and lymphoid infiltration of the tumor are associated with longer survival, as are favorable nuclear grade and tumor grade determinations. Each of these factors is also associated with a more favorable extent of disease. In contrast with breast cancer, sinus histiocytosis of the regional lymph nodes is infrequently seen. The prognostic influence of the aforementioned factors could not be explained by taking histologic type into account. This study provides further evidence in support of a tumor-host interaction wherein a significant component of host response is mediated by lymphoreticuloendothelial system.

A series of nearly 900 Norwegian women with cancer of the breast provides further evidence of the prognostic significance of the structural characteristics of the tumor and the lymph nodes, e.g., nuclear grade and sinus histiocytosis. The percentage of patients with evidence of a histiocytic reaction in the lymph nodes was found to depend on the number of nodes examined. Among patients with at least 6 nodes available for review, one third exhibited a histiocytic reaction. In the group in which 6 or more nodes were examined, the percentage of nodes with metastases is a powerful prognostic factor. In the presence of at least one favorable factor, such as a small tumor, histiocytic reaction in the nodes, or favorable nuclear grade, the survival of patients with metastases in less than one third of the axillary nodes is similar to survival of patients with no nodal metastases. The relationship of histologic type to other structural characteristics was investigated. Mucinous tumors had a high percentage with favorable nuclear grade. Medullary tumors had a high percentage with unfavorable nuclear grade, but the influence of this factor on survival was counterbalanced by the presence of lymphoid infiltrate in the tumor. The findings in this study suggest that more intensive study of the dynamic interactions between cancer and the lymphoicticulocndothelial system will provide insight into the behavior of human cancer.

Background. For stage I and II breast cancer, the standard treatment is partial mastectomy followed by radiation treatment. The risk of local recurrence ranges from 6 to 9%. A controversy exists as to whether there is an increased risk of local recurrence as a result of excessive delay between surgery and radiation treatment. A natural experiment associated with a prolonged waiting time in our institution provided an opportunity to evaluate the impact of waiting times for radiation treatment of breast cancer on the risk of local recurrence. Methods. Between January 1988 and December 1989, 486 patients with stage I or II breast cancer from McGill hospitals were treated with radiotherapy. Their charts were reviewed, and information with regard to prognostic factors, such as age, tumor size, histological grade, number of positive lymph nodes, and margins of resection, was abstracted. The interval between the date of surgery and the date of initial radiation treatment, and events, such as local recurrence, metastases and death, were noted. Results. At five years, the local recurrence rate was 8%, the metastatic rate 13%, and the disease-free survival rate 89%. In the univariate analysis, the risk of local recurrence was associated with younger age, higher histological grade, and time to radiation treatment. In the multivariate Cox proportional hazard models, higher histological grade and time to radiation treatment were significant. Using recursive partitioning, the risk of local recurrence was almost five times higher for patients who waited in excess of 79 days for radiation treatment. Conclusion. Delay in radiation treatment is associated with an increased risk of local recurrence of breast cancer.