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

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.

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

2003 ◽  
Vol 21 (17) ◽  
pp. 3244-3248 ◽  
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.

scholarly journals Validation of the Eighth American Joint Committee on Cancer Anatomic and Prognostic Staging System for Breast Cancer

2022 ◽  
Vol 270 ◽  
pp. 539-546
Author(s):  
Pei-dong Yang ◽  
Qing-Qin Peng ◽  
Wei-bin Lian ◽  
Fang-meng Fu ◽  
Chuan Wang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Staging System ◽  
American Joint Committee ◽  
Prognostic Staging System

scholarly journals Construction and Validation of Novel Prediction Tools Based on Large Population-Based Database to Predict the Prognosis of Urachal Cancer After Surgery

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaowen Yu ◽  
Chong Ma ◽  
Maoyu Wang ◽  
Yidie Ying ◽  
Zhensheng Zhang ◽  
...  
Keyword(s):  
Validation Cohort ◽  
Large Population ◽  
External Validation ◽  
Staging System ◽  
Cox Proportional Hazards ◽  
Clinicopathological Parameters ◽  
Patient Counseling ◽  
Cancer Specific Survival ◽  
Discriminative Ability ◽  
Urachal Cancer

BackgroundUrachal cancer is a rare neoplasm in the urological system. To our knowledge, no published study has explored to establish a model for predicting the prognosis of urachal cancer. The present study aims to develop and validate nomograms for predicting the prognosis of urachal cancer based on clinicopathological parameters.MethodsBased on the data from the Surveillance, Epidemiology, and End Results database, 445 patients diagnosed with urachal cancer between 1975 and 2018 were identified as training and internal validation cohort; 84 patients diagnosed as urachal cancer from 2001 to 2020 in two medical centers were collected as external validation cohort. Nomograms were developed using a multivariate Cox proportional hazards regression analysis in the training cohort, and their performance was evaluated in terms of its discriminative ability, calibration, and clinical usefulness by statistical analysis.ResultsThree nomograms based on tumor–node–metastasis (TNM), Sheldon and Mayo staging system were developed for predicting cancer-specific survival (CSS) of urachal cancer; these nomograms all showed similar calibration and discrimination ability. Further internal (c-index 0.78) and external (c-index 0.81) validation suggested that Sheldon model had superior discrimination and calibration ability in predicting CSS than the other two models. Moreover, we found that the Sheldon model was able to successfully classify patients into different risk of mortality both in internal and external validation cohorts. Decision curve analysis proved that the nomogram was clinically useful and applicable.ConclusionsThe nomogram model with Sheldon staging system was recommended for predicting the prognosis of urachal cancer. The proposed nomograms have promising clinical applicability to help clinicians on individualized patient counseling, decision-making, and clinical trial designing.

scholarly journals Staging for Breast Cancer With Internal Mammary Lymph Nodes Metastasis: Utility of Incorporating Biologic Factors

2021 ◽  
Vol 10 ◽  
Author(s):  
Chen-Lu Lian ◽  
Hai-Yan Zhang ◽  
Jun Wang ◽  
Jian Lei ◽  
Li Hua ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Staging System ◽  
Disease Stage ◽  
Rank Test ◽  
Breast Cancer Patients ◽  
Internal Mammary Lymph Nodes ◽  
Internal Mammary ◽  
Prognostic Staging System

PurposeTo validate the 8th edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging system for breast cancer patients with internal mammary lymph nodes (IMN) metastasis (N3b disease, stage IIIC in 7th AJCC anatomical staging).MethodsBreast cancer patients with IMN metastasis diagnosed between 2010 and 2014 were retrieved from the Surveillance, Epidemiology, and End Results program. Chi-squared test, Log-rank test, Kaplan-Meier method, and Cox proportional hazard analysis were applied to statistical analysis.ResultsWe included 678 patients with N3b disease in this study. Overall, 68.4% of patients were downstaged to IIIA and IIIB diseases from the 7th anatomical staging to 8th pathological prognostic staging. The new pathological prognostic staging system had better discriminatory value on prognosis prediction among IMN-metastasized breast cancer patients, with a 5-year breast cancer-specific survival (BCSS) of 92.7, 77.4, and 66.0% in stage IIIA, IIIB, and IIIC diseases, respectively (P&lt;0.0001), and the 5-year overall survival (OS) rates was 85.9, 72.1, and 58.7%, respectively (P&lt;0.0001). The results of the multivariate prognostic analysis showed that the new pathological prognostic staging was the independent prognosis related to BCSS and OS, the 8th AJCC pathological prognostic stages showed worse BCSS and OS with gradually increased hazard ratios.ConclusionThe 8th AJCC pathological prognostic staging system offers more refined prognostic stratification to IMN-metastasized breast cancer patients and endorses its use in routine clinical practice for this specific subgroup of breast cancer.

Prognostic impact of the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system on clinically negative lymph nodes (cN0) breast cancer patients

2020 ◽  
Vol 26 (7) ◽  
pp. 1265-1269 ◽  
Author(s):  
Augusto Lombardi ◽  
Valeria Vitale ◽  
Giuseppe Nigri ◽  
Carlotta Olivieri ◽  
Maria Rosaria Mastrangeli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Nodes ◽  
Cancer Patients ◽  
Staging System ◽  
Cancer Staging ◽  
Prognostic Impact ◽  
Breast Cancer Patients ◽  
American Joint Committee ◽  
Negative Lymph Nodes ◽  
8Th Edition

scholarly journals Molecular Subtype May Be More Associated With Prognosis and Chemotherapy Benefit Than Tumor Size in T1N0 Breast Cancer Patients: An Analysis of 2,168 Patients for Possible De-Escalation Treatment

2021 ◽  
Vol 11 ◽  
Author(s):  
Siji Zhu ◽  
Yafen Li ◽  
Weiguo Chen ◽  
Xiaochun Fei ◽  
Kunwei Shen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Tumor Size ◽  
Proportional Hazards ◽  
Cox Regression ◽  
Molecular Subtype ◽  
Growth Factor Receptor ◽  
Disease Free Survival ◽  
Cox Proportional Hazards ◽  
Breast Cancer Patients ◽  
Cancer Specific Survival

PurposeBreast cancer (BC) patients with T1N0 tumors have relatively favorable clinical outcomes. However, it remains unclear whether molecular subtypes can aide in prognostic prediction for such small, nodal-negative BC cases and guide decision-making about escalating or de-escalating treatments.Patients and MethodsT1N0 BC patients diagnosed between 2009 and 2017 were included and classified into three subgroups according to receptor status: 1) hormonal receptor (HR)+/human epidermal growth factor receptor-2 (HER2)−; 2) HER2+; and 3) triple negative (TN) (HR−/HER2−). Patients’ characteristics and relapse events were reviewed. Kaplan–Meier analysis and Cox regression were used to assess the iDFS and BCSS. The effects of risk factors and adjuvant treatment benefits were evaluated by calculating hazard ratios (HRs) for invasive disease-free survival (iDFS) and breast cancer-specific survival (BCSS) with Cox proportional hazards models.ResultsIn total, 2,168 patients (1,435 HR+/HER2−, 427 HER2+, 306 TN) were enrolled. The 5-year iDFS rates were 93.6, 92.7, and 90.6% for HR+/HER2−, HER2+, and TN patients, respectively (P = 0.039). Multivariate analysis demonstrated that molecular subtype (P = 0.043), but not tumor size (P = 0.805), was independently associated with iDFS in T1N0 BC. TN patients [HRs = 1.77, 95% confidence interval (CI) = 1.11–2.84, P = 0.018] had a higher recurrence risk than HR+/HER2− patients. Adjuvant chemotherapy benefit was not demonstrated in all T1N0 patients but interacted with molecular subtype status. TN (adjusted HRs = 2.31, 95% CI = 0.68–7.54) and HER2+ (adjusted HRs = 2.26, 95% CI = 0.95–5.63) patients receiving chemotherapy had superior iDFS rates. Regarding BCSS, molecular subtype tended to be related to outcome (P = 0.053) and associated with chemotherapy benefit (P = 0.005).ConclusionMolecular subtype was more associated with disease outcome and chemotherapy benefit than tumor size in T1N0 BC patients, indicating that it may guide possible clinical de-escalating therapy in T1N0 BC.

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