Best prognosis for carcinoma breast is seen with which of the following?

Ans. is 'a' i.e., <lcm size, nodes -ve , ER/ PR +ve, her 2/ neu -ve Prognostic factors of breast carcinoma* The most important prognostic variables are provided by tumor staging.* The size of the tumor and the status of the axillary lymph nodes provide reasonably accurate information on the likelihood of tumor relapse.* There is rarely justification for adjuvant chemotherapy in most women with tumors <1 cm in size whose axillary lymph nodes are negative. HER2-positive tumors are a potential exception.* Detection of breast cancer cells either in the circulation or bone marrow is associated with an increased relapse rate.* Estrogen and progesterone receptor status are of prognostic significance. Tumors that lack either or both of these receptors are more likely to recur than tumors that have them.* Several measures of tumor growth rate correlate with early relapse. S-phase analysis using flow cytometry is the most accurate measure. Indirect S-phase assessments using antigens associated with the cell cycle, such as PCNA (Ki67), are also valuable.* Tumors with a high proportion (more than the median) of cells in S-phase pose a greater risk of relapse; chemotherapy offers the greatest survival benefit for these tumors.* Assessment of DNA content in the form of ploidy is of modest value, with nondiploid tumors having a somewhat worse prognosis.* Histologic classification of the tumor has also been used as a prognostic factor. Tumors with a poor nuclear grade have a higher risk of recurrence than tumors with a good nuclear grade.* Molecular changes in the tumor are also useful. Tumors that overexpress erbB2 (HER2/neu) or have a mutated p53 gene have a worse prognosis. Tumors that overexpress erbB2 are more likely to respond to higher doses of doxorubicin- containing regimens and predict those tumors that will respond to HER2/neu antibodies (trastuzumab) (herceptin) and HER2/ neu kinase inhibitors.* The presence of more microvessels in a tumor, particularly when localized in so-called hot spots, is associated with a worse prognosis.* Other variables that have also been used to evaluate prognosis include proteins associated with invasiveness, such as type IV collagenase, cathepsin D, plasminogen activator, plasminogen activator receptor, and the metastasis- suppressor gene nm23. None of these has been widely accepted as a prognostic variable for therapeutic decision- making. One problem in interpreting these prognostic variables is that most of them have not been examined in a study using a large cohort of patients.