Abstract
Purpose: The objective of this study was to evaluate the American Joint Committee on Cancer (AJCC) pathological prognostic stage among patients with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) and to propose a modified score system if necessary.Methods: Women diagnosed with IDC and ILC during 2010–2015 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively identified. Disease-specific survival (DSS) and overall survival (OS) were estimated by Kaplan–Meier method. Predictive performances of different staging systems were evaluated based on Harrell concordance index (C-index) and Akaike Information Criterion (AIC). Multivariate Cox models were conducted to build preferable score systems.Results: A total of 184,541 female patients were included in the final analyses, with a median follow-up of 30.0 months. In IDC cohort, the pathological prognostic stage (C-index, 0.8281; AIC, 110274.5) was superior to the anatomic stage (C-index, 0.8125; AIC, 112537.0; P < 0.001 for C-index) in risk stratification with respect to DSS. In ILC cohort, the prognostic stage (C-index, 0.8281; AIC, 7124.423) didn't outperform the anatomic stage (C-index, 0.8324; AIC, 7144.818; P = 0.748 for C-index) with respect to DSS. Similar results were observed with respect to OS. The score system defined by anatomic stage plus grade plus estrogen receptor and progesterone receptor (AS+GEP) allows for better staging (C-index, 0.8085; AIC, 7178.448) for ILC patients.Conclusion: Compared with anatomic stage, the pathological prognostic stage provided more accurate stratification for patients with IDC, but not for patients with ILC. The AS+GEP score system may fit ILC tumors better.
Highlights
Tumor staging is of critical significance in risk stratification and prognosis prediction for breast cancer
Among 180,652 patients diagnosed with Invasive ductal carcinoma (IDC), 10,413 (5.7%) patients with unknown estrogen receptor (ER), progesterone receptor (PR), or human epidermal growth factor receptor 2 (HER2) status and 4,155 (2.3%) patients without tumor grade information were further excluded
Among 20,423 patients diagnosed with invasive lobular carcinoma (ILC), 970 (4.7%) patients with unknown ER, PR or HER2 status and 996 (4.9%) patients without tumor grade information were further excluded
Summary
Tumor staging is of critical significance in risk stratification and prognosis prediction for breast cancer. Since its first publication in 1977, the American Joint Committee on Cancer (AJCC) Cancer Staging Manual has been periodically revised and updated to improve its predictive accuracy in stratifying patients outcomes [1]. AJCC 8th edition staging manual introduced the prognostic stage system (PS) by incorporating biomarkers including estrogen receptor (ER) and progesterone receptor (PR) expression, human epidermal growth factor receptor 2 (HER2) status, tumor grade, as well as multigene assays when available, with TNM classification, while maintaining the TNM-based anatomic stage system(AS) [6]. After further analysis based on National Cancer Database (NCDB), the AJCC Breast Expert Panel provided an updated version of the breast staging manual to further refine the patient stratification [7]. The prognostic value of the PS in different histology subtypes of breast cancer has not been evaluated yet, which requires further validation
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