Validation of the pathological prognostic staging system proposed in the revised eighth edition of the AJCC staging manual in different molecular subtypes of breast cancer

Expanded understanding of biologic factors that modulate the clinical course of malignant disease have led to the gradual integration of biomarkers into staging classifications. The American Joint Committee on Cancer (AJCC) TNM staging system is universally used and has largely displaced other staging classifications for most, although not all, cancers. Many of the chapters of the eighth edition of the AJCC TNM staging system integrated biomarkers with anatomic definitions. The Breast Chapter added estrogen receptor (ER) and progesterone receptor (PR) expression, HER2 expression, and/or amplification and histologic grade to the anatomic assessment of tumor size, regional lymph node involvement, and distant metastases (known as TNM). While preserving an anatomic staging system for continuity and for regions where modern biomarkers are not always available, the eighth edition emphasizes the increased prognostic precision of the clinical prognostic stage groups and the pathologic prognostic stage groups. The clinical prognostic stage groups are applicable to all patients with primary breast cancer before any treatment has been implemented, but require a clinical and imaging evaluation as well as a biopsy with grade and available ER, PR, and HER2 results; the pathologic prognostic stage groups are applicable to all patients treated with complete surgical excision as first treatment and also require a complete pathology report, grade, and ER, PR, and HER2. Applying the pathologic prognostic stage groups to a large database of patients staged by basic TNM groupings changed the stage grouping of almost 40% of patients. Grouping by pathologic prognostic stage groups led to a better prognostic distribution of the group and more precise individual prognostication.

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Prognostic and Predictive Value of the American Joint Committee on Cancer Pathological Prognostic Staging System in Nodal Micrometastatic Breast Cancer

Frontiers in Oncology ◽

10.3389/fonc.2020.570175 ◽

2020 ◽

Vol 10 ◽

Author(s):

Jian Shi ◽

Chen-Lu Lian ◽

Feng Chi ◽

Ping Zhou ◽

Jian Lei ◽

...

Keyword(s):

Breast Cancer ◽

Regression Model ◽

Staging System ◽

Cox Proportional Hazards ◽

Breast Cancer Patients ◽

Operating Characteristics ◽

Cancer Specific Survival ◽

Discriminative Ability ◽

American Joint Committee ◽

Prognostic Staging System

IntroductionTo investigate the prognostic and predictive effect of the American Joint Committee on Cancer (AJCC) 8th edition pathological prognostic staging system in patients with T1-2N1micM0 breast cancer who underwent mastectomy.MethodsData from T1-2N1micM0 breast cancer patients who underwent mastectomy from 2010–2014 were obtained from the Surveillance, Epidemiology, and End Results program. The chi-square test, binomial logistics regression, receiver-operating characteristics curve, competing-risk regression model, Cox proportional hazards regression model, and proportional hazard assumption were used for statistical analyses.ResultsWe identified 4,729 patients, including 1,062 patients were received postmastectomy radiotherapy (PMRT). Stage change occurred in 88.2% of the patients, of which 84.4% were downstaged and 3.7% were upstaged. Patients with higher pathological prognostic stages were independently predicted to receive PMRT. The 5-year breast cancer-specific survival (BCSS) was 97.5, 93.7, 90.1, 86.0, and 73.5% in disease stages IA, IB, IIA, IIB, and IIIA, respectively, according to the 8th edition criteria (P < 0.001). The AJCC 8th edition demonstrated moderate discriminative ability, and it had a significantly better ability to predict the BCSS than the AJCC 7th edition criteria (P < 0.001). The multivariate prognostic analysis showed that the new pathological prognostic staging was an independent prognostic factor affecting the BCSS. The BCSS worsened with an increase in the stage. The PMRT did not affect the BCSS regardless of the pathological prognostic stage. Similar trends were found using the competing-risks regression model.ConclusionsThe 8th AJCC breast cancer pathological prognostic staging system downstaged 84.4% of patients with T1-2N1micM0 disease and the survival outcome prediction with this staging system was more accurate than the AJCC 7th edition system. Our study does not support using the prognostic stage as a guideline to escalate of PMRT.

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Prognostic Stage Groups Established by AJCC Staging System 8th Edition Does Not Significantly Improve Discrimination Over Classic TNM Staging in Early Stage Breast Cancer Treated With Breast Conservative Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.06.607 ◽

2017 ◽

Vol 99 (2) ◽

pp. E7

Author(s):

S. Chen ◽

S. Wang ◽

Y. Tang ◽

Z.H. Yu ◽

J. Jin ◽

...

Keyword(s):

Breast Cancer ◽

Conservative Therapy ◽

Early Stage ◽

Staging System ◽

Tnm Staging ◽

Early Stage Breast Cancer ◽

Breast Conservative Therapy ◽

Ajcc Staging System ◽

Ajcc Staging ◽

8Th Edition

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P17 Comparison between the 5th and 6th American JointCommittee on Cancer (AJCC) staging system in 1,275 breast cancer patients

The Breast ◽

10.1016/s0960-9776(05)80056-6 ◽

2005 ◽

Vol 14 ◽

pp. S19

Author(s):

S.H. Kang ◽

K.H. Jung ◽

S.J. Lee ◽

K.B. Kwun

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Staging System ◽

Breast Cancer Patients ◽

Ajcc Staging System ◽

Ajcc Staging

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Changes in the 2003 American Joint Committee on Cancer Staging for Breast Cancer Dramatically Affect Stage-Specific Survival

Journal of Clinical Oncology ◽

10.1200/jco.2003.03.052 ◽

2003 ◽

Vol 21 (17) ◽

pp. 3244-3248 ◽

Cited By ~ 94

Author(s):

Wendy A. Woodward ◽

Eric A. Strom ◽

Susan L. Tucker ◽

Marsha D. McNeese ◽

George H. Perkins ◽

...

Keyword(s):

Breast Cancer ◽

Treatment Strategies ◽

Staging System ◽

Stage Ii ◽

Rank Test ◽

Breast Cancer Patients ◽

American Joint Committee ◽

Number Of Patients ◽

Ajcc Staging System ◽

Ajcc Staging

Purpose: To evaluate how implementation of the 2003 American Joint Committee on Cancer (AJCC) staging system will affect stage-specific survival of breast cancer patients. Patients and Methods: Records of 1,350 patients treated on sequential institutional protocols with mastectomy and adjuvant doxorubicin-based chemotherapy were reviewed. Pathologic stage was assigned retrospectively according to the 1988 and the 2003 AJCC staging criteria. Overall stage-specific survival (OS) was calculated using the Kaplan-Meier method, and hypothetical differences were compared by the log-rank test. Results: Six hundred five of 1,087 patients with stage II disease according to the 1988 classification system had stage II disease according to the 2003 system. The 10-year OS for patients with stage II disease was significantly improved using the 2003 system (76% [2003] v 65% [1988]; P < .0001). Two hundred eighty-nine of 633 patients with stage IIb disease using the 1988 system were stage IIb with the 2003 system, and 10-year OS was 58% (1988) versus 70% (2003; P = .003). The number of patients with stage III disease increased from 207 (1988) to 443 (2003), and the 10-year OS changed from 45% (1988) to 50% (2003; P = .077). Most of this difference resulted from changes within stage IIIa: OS, 45% (1988) versus 59% (2003; P < .0001). Conclusion: Stage reclassification using the new AJCC staging system for breast cancer will result in significant changes in reported outcome by stage. It is imperative that careful attention is devoted to this effect so that accurate conclusions regarding the efficacy of new treatment strategies can be drawn.

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