Abstract
BackgroundThe 8th edition American Joint Committee on Cancer (AJCC) proposed a prognostic stage (PS), which included not only anatomical factors, but also biological factors. We aimed to investigate the clinicopathological significance of the PS and to compare PS and anatomical stage (AS) that has been established by the Union for International Cancer Control (UICC).MethodsBetween 2002 and 2017, 800 patients were included in the study. Patients were classified using pathological UICC AS and pathological AJCC PS. The usefulness of PS in comparison with AS was validated using the Akaike information criterion (AIC) and Harrell concordance index (C-index).ResultsA total of 401 (50.1%) patients had pathological AS I, 324 (40.5%) had AS II, and 75 (9.4%) had AS III. Meanwhile, 535 (66.8%) had pathological PS I, 163 (20.4%) had PS II, and 102 (12.8%) had PS III. The number of AS II cases was 1.99-fold higher than that of PS II cases. For each stage, these survival curves were almost similar between AS and PS classification. Therefore, many patients to be classified into stage I and stage III were included in AS II group, while many patients to be classified into stage II were included in AS I group. To trichotomize the survival groups, PS appeared to be more specific than AS, and AIC and C-index confirmed the speculation.ConclusionFor the prognostication of primary breast cancer patients, AJCC PS appeared to be able to stratify the cases more appropriately than UICC AS.
Highlights
Breast cancer is the most frequent malignant disease, the number of the patients who were newly diagnosed with breast cancer was 1.8 million, and 471,000 died of breast cancer in 2013 [1]
Between January 2002 and December 2017, radical surgery was performed for the 1159 patients who were diagnosed as histologically primary carcinoma of the breast
From the 800 patients, we acquired the data of sex, age, pathological tumor size, pathological tumor invasion size, pT, pN, lymphatic invasion, histological grade (HG), nuclear grade (NG), estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) status, Ki-67 labeling index, histological type, pathological Union for International Cancer Control (UICC) anatomical stage (AS), pathological American Joint Committee on Cancer (AJCC) prognostic stage (PS), pathological PS-NG, procedure, medication therapy, radiation therapy, relapse-free survival rate, and overall survival rate (Table 1)
Summary
Breast cancer is the most frequent malignant disease, the number of the patients who were newly diagnosed with breast cancer was 1.8 million, and 471,000 died of breast cancer in 2013 [1]. Tumor staging system codified by Union for International Cancer Control (UICC) started in 1933, and is maintained by both the UICC and American Joint Committee on Cancer (AJCC). This system was based on the anatomical factors [primary tumor (T), regional lymph node (N), and distant metastasis (M)], and called the TNM classification system or anatomical stage (AS). The 8th edition American Joint Committee on Cancer (AJCC) proposed a prognostic stage (PS), which included anatomical factors, and biological factors. Conclusion For the prognostication of primary breast cancer patients, AJCC PS appeared to be able to stratify the cases more appropriately than UICC AS
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