Abstract
We investigated the relationship between the prognostic importance of anatomic tumour burden and subtypes of breast cancer using data from the Korean Breast Cancer Registry Database. In HR+/HER2+ and HR−/HER2−tumours, an increase in T stage profoundly increased the hazard of death, while the presence of lymph node metastasis was more important in HR+/HER2+ and HR−/HER2+ tumours among 131,178 patients with stage I–III breast cancer. The patterns of increasing mortality risk and tumour growth (per centimetre) and metastatic nodes (per node) were examined in 67,038 patients with a tumour diameter ≤ 7 cm and < 8 metastatic nodes. HR+/HER2− and HR−/HER2− tumours showed a persistent increase in mortality risk with an increase in tumour diameter, while the effect was modest in HER2+ tumours. Conversely, an increased number of metastatic nodes was accompanied by a persistently increased risk in HR−/HER2+ tumours, while the effect was minimal for HR−/HER2− tumours with > 3 or 4 nodes. The interactions between the prognostic significance of anatomic tumour burden and subtypes were significant. The prognostic relevance of the anatomic tumour burden was non-linear and highly dependent on the subtypes of breast cancer.
Highlights
We investigated the relationship between the prognostic importance of anatomic tumour burden and subtypes of breast cancer using data from the Korean Breast Cancer Registry Database
Since the analyses were not stratified by molecular subtype, the scoring system assumes that changes in tumour size and nodal status result in similar prognostic effects among different tumour subtypes
When the patients were classified according to the hormone receptor and HER2-overexpression status, we observed that the degree of the prognostic impact of TNM staging varied according to the subtypes (Fig. 1)
Summary
The prediction of recurrence of solid tumours has been mainly based on information regarding tumour size and nodal metastasis In addition to this anatomic staging information, clinicians have long considered the biologic characteristics of the tumour, such as the molecular subtype and histologic grade of breast cancer, as essential factors influencing survival outcomes. The validity of the 8th AJCC staging system originates from studies that examined the usefulness of the novel scoring system (Bioscore), which includes both anatomic and biologic information, in large cohorts of patients with breast c ancer[5,6] This scoring system was developed by calculating the degree of contribution for each prognostic factor (i.e., tumour size, node status, and ER status) based on the results of multivariate survival analyses. Some studies have shown possible interactions between the prognostic relevance of the anatomic staging factors and biologic characteristics of tumours in breast c ancer[7,8,9]
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