New and Important Changes in the TNM Staging System for Breast Cancer

2018 ◽  
pp. 457-467 ◽  
Author(s):  
Gabriel N. Hortobagyi ◽  
Stephen B. Edge ◽  
Armando Giuliano
Keyword(s):  
Breast Cancer ◽  
Regional Lymph Node ◽  
Staging System ◽  
Distant Metastases ◽  
Tnm Staging ◽  
Pathology Report ◽  
Imaging Evaluation ◽  
Complete Surgical Excision ◽  
Tnm Staging System ◽  
Eighth Edition

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.

RA10.06: THE ROLE AND PROGNOSTIC SIGNIFICANCE OF AORTOPULMONARY, ANTERIOR MEDIASTINAL, AND TRACHEOBRONCHIAL LYMPH NODES IN ESOPHAGEAL CANCER: UPDATE OF THE 2018 TNM STAGING SYSTEM

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 43-44
Author(s):  
Wen-Ping Wang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
Wei-Peng Hu ◽  
Long-Qi Chen
Keyword(s):  
Esophageal Cancer ◽  
Lymph Node ◽  
Regional Lymph Node ◽  
Prognostic Significance ◽  
Staging System ◽  
Tnm Staging ◽  
Therapeutic Value ◽  
Tnm Staging System ◽  
N Stage ◽  
Eighth Edition

Abstract Background The eighth edition of the American Joint Committee on Cancer TNM staging for esophageal cancer will be implemented at the beginning of 2018. The nodal staging process in the eighth edition remains unchanged from that in the seventh edition in that it was based on the number of lymph nodes (LNs) involved, but the regional lymph node map has been revised. The aortopulmonary (station 5), anterior mediastinal (station 6), and tracheobronchial (station 10) nodes have been omitted from the regional lymph node map for the new TNM staging. However, the role and prognostic significance of these LN stations are not clear. The purpose of this study was to investigate whether the revised nodal staging used in the eighth edition staging system is appropriate, and to verify the role, prognostic significance, and therapeutic value of these LNs in esophageal cancer. Methods The records of patients who underwent esophagectomy for cancer in our department between January 2007 and January 2013 were retrospectively analyzed. The rate of metastases and the index of estimated benefit from lymph node dissection (IEBLD) were calculated for stations 5, 6, and 10 LNs. LN metastasis and patient survival were analyzed and the efficacy of the eighth edition TNM staging system was verified. Results A total of 1637 patients (1350 men, 287 women) were included. The frequencies of dissection of stations 5, 6, and 10 LNs were 34.3% (562/1637), 15.9% (260/1637), and 50.9% (833/1637), respectively. The calculated rate of metastasis to these stations was 3.2% (18/562), 2.3% (6/260), and 4.9% (41/833), respectively. No difference was found in the N stage determined by the seventh and eighth edition N staging systems. The survival curves differed significantly between N stages calculated using the eighth edition TNM system (P < 0.001). The IEBLD values of stations 5, 6, and 10 LNs were 0.57, 0, and 0.97, respectively. Station 5 or 10 LN(+ ) patients had worse median survival time and 5-year overall survival rate compared with LN(–) patients (P < 0.01). Univariate analysis showed that differentiation, T stage, N stage (both seventh and eighth edition calculations), and metastasis to stations 5 and 10 LNs were associated with long-term survival. Conclusion Metastasis to stations 5, 6, or 10 LNs was infrequent. If stations 5, 6, and 10 LNs were omitted in the eighth edition calculation to determine the N stage based on the number of metastatic LNs, this did not influence the accuracy and survival-predicting efficacy of the eighth edition TNM staging. The therapeutic value of lymphadenectomy of stations 5, 6, and 10 was limited. Metastasis to stations 5, 6, and 10 LNs indicated more advanced N stage, which was associated with poor survival. However, no survival difference was found between station 6 LN(+ ) and LN(–) subgroups, possibly because of the limited numbers of cases. Disclosure All authors have declared no conflicts of interest.

The clinicopathological and survival analysis of urological mucosal melanoma: A single-center retrospective observational study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21588-e21588
Author(s):  
Bixia Tang ◽  
Xieqiao Yan ◽  
Zhihong Chi ◽  
Siming Li ◽  
Chuanliang Cui ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Regional Lymph Node ◽  
Stage Iv ◽  
Staging System ◽  
Tnm Staging ◽  
Mucosal Melanoma ◽  
Future Research ◽  
Molecular Characteristics ◽  
Urethral Carcinoma ◽  
Tnm Staging System

e21588 Background: Primary mucosal melanoma arising in the urinary tract is rare and poorly characterized. Methods: The records of patients with urological mucosal melanoma who presented to the department of Renal Cancer and Melanoma of Peking University Cancer Hospital between September, 2004 and April, 2019 were reviewed. Available clinicopathological and molecular characteristics were summarized, including pathological parameters, gene mutation, primary surgical intervention, systemic treatment and clinical course. The rates of local recurrence rate, loco-regional lymph node metastasis and distant metastasis were assessed. American Joint Committee on Cancer (AJCC) TNM Staging System for bladder cancer/renal pelvis and ureter cancer/urethral carcinoma (8th ed., 2017) were adopted for staging. Results: Fifty-eight patients were involved in the study with a median age of 62.5 years (range: 32-82). The anatomic sites of the primary urological mucosal melanomas were from the urethra (89.7%), bladder (6.9%), ureter (0%) and kidney (0%), and the left (4.4%) were from multiple loci. At initial diagnosis, 75.9% (n=44) were stage I/II disease, 1.7% (n=1) stage III, and 22.4% (n=13) stage IV. There was 3.4% incidence of CKIT mutation and 1.7% of BRAF mutation. After median follow-up of 22.6 mo, 31.4% (16/51) relapsed locally after organ-preserved surgery. 21.6% (11/51) and 39.2% (20/51) developed metastases to reginal lymph nodes and distance, respectively. The median relapse free survival and median overall survival were 12.2 (95%CI: 7.9-16.4) mo and 33.9 (95%CI: 19.2-48.6) mo, respectively. Univariate Cox analysis showed that TNM stage and systemic adjuvant therapy were the prognostic factors of OS, while no association was found with Breslow thickness, miotic rate, ulceration and gender. Conclusions: Urological mucosal melanoma predominantly arises from lower urinary tract with rare BRAF and CKIT mutation. AJCC TNM Staging System for urothelial carcinoma is proved practical for urothelial melanoma, which should be validated in larger population. Future research is required to identify adjuvant treatment approaches to improve disease outcomes.

scholarly journals Inflammatory breast cancer: a proposed conceptual shift in the UICC–AJCC TNM staging system

2017 ◽  
Vol 18 (4) ◽  
pp. e228-e232 ◽  
Author(s):  
Tamer M Fouad ◽  
Angelica M Gutierrez Barrera ◽  
James M Reuben ◽  
Anthony Lucci ◽  
Wendy A Woodward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Conceptual Shift

The 2003 Revised TNM Staging System for Breast Cancer: Results of Stage Re-classification on Survival and Future Comparisons among Stage Groups

2006 ◽  
Vol 14 (1) ◽  
pp. 143-147 ◽  
Author(s):  
Pedro F Escobar ◽  
Rebecca J Patrick ◽  
Lisa A Rybicki ◽  
David E Weng ◽  
Joseph P Crowe
Keyword(s):  
Breast Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System

scholarly journals Molecular characterization of breast cancer: a potential novel immune-related lncRNAs signature

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Jianguo Lai ◽  
Bo Chen ◽  
Guochun Zhang ◽  
Xuerui Li ◽  
Hsiaopei Mok ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Stratification ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
Expression Profiles ◽  
Treatment Strategies ◽  
Staging System ◽  
Tnm Staging ◽  
The Cancer Genome Atlas ◽  
Tnm Staging System

Abstract Background Accumulating evidence has demonstrated that immune-related lncRNAs (IRLs) are commonly aberrantly expressed in breast cancer (BC). Thus, we aimed to establish an IRL-based tool to improve prognosis prediction in BC patients. Methods We obtained IRL expression profiles in large BC cohorts (N = 911) from The Cancer Genome Atlas (TCGA) database. Then, in light of the correlation between each IRL and recurrence-free survival (RFS), we screened prognostic IRL signatures to construct a novel RFS nomogram via a Cox regression model. Subsequently, the performance of the IRL-based model was evaluated through discrimination, calibration ability, risk stratification ability and decision curve analysis (DCA). Results A total of 52 IRLs were obtained from TCGA. Based on multivariate Cox regression analyses, four IRLs (A1BG-AS1, AC004477.3, AC004585.1 and AC004854.2) and two risk parameters (tumor subtype and TNM stage) were utilized as independent indicators to develop a novel prognostic model. In terms of predictive accuracy, the IRL-based model was distinctly superior to the TNM staging system (AUC: 0.728 VS 0.673, P = 0.010). DCA indicated that our nomogram had favorable clinical practicability. In addition, risk stratification analysis showed that the IRL-based tool efficiently divided BC patients into high- and low-risk groups (P < 0.001). Conclusions A novel IRL-based model was constructed to predict the risk of 5-year RFS in BC. Our model can improve the predictive power of the TNM staging system and identify high-risk patients with tumor recurrence to implement more appropriate treatment strategies.

Abstract P6-08-15: Deconstructing the TNM staging system for breast cancer

2015 ◽  
Author(s):  
Jigar A Patel ◽  
Matthew T Hueman ◽  
Dechang Chen ◽  
Donald E Henson
Keyword(s):  
Breast Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System
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