Changes of breast cancer staging when AJCC prognostic staging manual is used: a retrospective analysis of a Chinese cohort

Ding, Jinhua; Wu, Weizhu; Fang, Jianjiang; Chu, Yen-Ping; Zheng, Shuying; Jiang, Li

doi:10.5301/ijbm.5000302

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…16 In our study, 215 (52.8%) patients changed their pathological stages when the 8th edition AJCC PS was used, which was in line with that in our previous study. 21 In this study, the 5-year DSS rates in the anatomic stage I, II, and III groups were 96.7%, 92.6%, 69.0%, and 97.2%, 90.9%, and 69.5% in the prognostic stage I, II, and III groups, respectively, and there were statistically significant differences between the different staging groups regardless of the staging system. Similarly, the 5-year OS rates in the anatomic stage I, II, and III groups were 98.0%, 94.2% and 77.9%, and 98.6%, 93.6% and 77.4% in the prognostic stage I, II, and III groups, respectively, and there were statistically significant differences between the different staging groups regardless of staging system.…”

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confidence: 48%

Validation of the Prognostic Stage from the American Joint Committee on Cancer 8th Staging Manual in Luminal B-Like Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer

Ding¹,

Jiang²,

Xu³

et al. 2022

CMAR

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The 8th edition American Joint Committee on Cancer (AJCC) prognostic staging system (PS) has been validated numerous times; however, the prognostic value of PS for breast cancer based on molecular subtype has rarely been explored. This study aimed to investigate the prognostic value of PS in Chinese patients with luminal B-like human epidermal growth factor receptor 2 (HER2)negative breast cancer. Methods: A total of 407 eligible cases were included in the study. All of the cases were restaged using the 8th edition AJCC Anatomic Staging System (AS) and PS. The Kaplan-Meier method was used to calculate estimated survival and the Log rank test was used to compare the survival differences between groups. Results:The 5-year disease-specific survival (DSS) and overall survival (OS) rates were 90.3% and 93.5%, respectively, and there were statistically significant differences in the 5-year DSS and 5-year OS rates among the different anatomic and prognostic stage groups. The application of the PS resulted in the assignment of 215 (52.8%) patients to a different group. Different prognostic stage groups restaged from anatomic Stage III had significant differences in both DSS (χ 2 = 4.366, p = 0.037) and OS (χ 2 = 7.549, p = 0.006); additionally, different prognostic stage groups from the anatomic Stage II group had significant differences in DSS (χ 2 = 7.724, p = 0.021) but no significant differences in OS (χ 2 = 5.182, p = 0.075). However, different prognostic stage groups from anatomic Stage I had no significant differences in either DSS (χ 2 = 0.159, p = 0.690) or OS (χ 2 = 0.099, p = 0.753). Conclusion:The 8th edition AJCC PS refined the anatomic stage grouping in luminal B-like HER2-negative breast cancer and could lead to a more personalized approach to breast cancer treatment.

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confidence: 48%

Validation of the Prognostic Stage from the American Joint Committee on Cancer 8th Staging Manual in Luminal B-Like Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer

Ding¹,

Jiang²,

Xu³

et al. 2022

CMAR

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“…Immunity-associated parameters, potential predictors, and therapeutic targets for non-BRCA carriers with TNBC were not included in these studies, either. Furthermore, TNBCs with a high tumor burden were associated with worse prognosis (36) and required the identification of distinct prognostic predictors and potential therapeutic targets.…”

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confidence: 99%

Genomic Profiling Comparison of Germline BRCA and Non-BRCA Carriers Reveals CCNE1 Amplification as a Risk Factor for Non-BRCA Carriers in Patients With Triple-Negative Breast Cancer

Huang

Шао

et al. 2020

Front. Oncol.

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Background: Differences in genomic profiling and immunity-associated parameters between germline BRCA and non-BRCA carriers in TNBC with high tumor burden remain unexplored. This study aimed to compare the differences and explore potential prognostic predictors and therapeutic targets. Methods:The study cohort included 21 consecutive TNBC cases with germline BRCA1/2 mutations and 54 non-BRCA carriers with a tumor size ≥ 2 cm and/or ≥1 affected lymph nodes. Differences in clinicopathological characteristics and genomic profiles were analyzed through next-generation sequencing. Univariate Kaplan-Meier analysis and Cox regression model were applied to survival analysis. Immunohistochemistry was used to confirm the consistency between CCNE1 amplification and cyclin E1 protein overexpression.Results: The cohort included 16 and five patients with germline BRCA1 and BRCA2 mutations, respectively. Patients with germline BRCA1/2 mutations were diagnosed at a significantly younger age and were more likely to have a family history of breast and/or ovarian cancer. Six non-BRCA carriers (11.11%) carried germline mutations in other cancer susceptibility genes, including five mutations in five homologous recombination repair (HRR) pathway genes (9.26%) and one mutation in MSH3 (1.85%). Somatic mutations in HRR pathway genes were found in 22.22 and 14.29% of the non-BRCA and BRCA carriers, respectively. PIK3CA missense mutation (p = 0.046) and CCNE1 amplification (p = 0.2) were found only in the non-BRCA carriers. The median tumor mutation burden (TMB) was 4.1 Muts/Mb, whereas none of the cases had high microsatellite instability (MSI). BRCA status did not affect disease-free survival (DFS, p = 0.15) or overall survival (OS, p = 0.52). CCNE1 amplification was an independent risk factor for DFS in non-BRCA carriers with TNBC (HR 13.07, 95% CI 2.47-69.24, Huang et al.BRCA and Non-BRCA Carrier Genomic Profiling p = 0.003). Consistency between CCNE1 amplification and cyclin E1 protein overexpression was confirmed with an AUC of 0.967 for cyclin E1 signal intensity.Conclusions: We found differences in genetic alterations between germline BRCA and non-BRCA carriers with TNBC and a high tumor burden. TMB and MSI may not be suitable predictors of TNBC for immune checkpoint inhibitors. Notably, CCNE1 amplification is a novel potential prognostic marker and therapeutic target for non-BRCA carriers with TNBC. Cyclin E1 may be used instead of CCNE1 to improve clinical applicability.

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“…OncotypeDx™, the only genomic profile assay with level I evidence at the time of drafting of the AJCC 8th edition, is also included in the PS system, and any T1-2, N0, and ER+/HER− BC with RS <11 is now classified as stage group IA, independent of size. 3 In recent retrospective studies, [4][5][6][7][8][9][10][11] staging BC using the TNM + Biomarkers (PS) system showed more specific correlation with clinical follow-up than staging using the TNM stage system. Most of the published studies evaluated BC patients from Asia 6,7,10,12 or from the Southwest region of the USA.…”

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confidence: 99%

Impact of biomarkers and genetic profiling on breast cancer prognostication: A comparative analysis of the 8th edition of breast cancer staging system

et al. 2019

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The 8th edition of the American Joint Committee on Cancer (AJCC) staging guidelines combine traditional TNM system with biomarkers to reflect our current understanding of tumor biology and targeted therapy. In this study, we investigated the impact of the TNM + Biomarkers staging system and the additive value of Oncotype Dx™ genomic profile recurrence score (RS) (TNM + Biomarkers+RS <11) for the staging of breast cancer (BC) using data from two tertiary referral cancer centers. Compared to TNM alone, the TNM + Biomarkers system changed the stage group in 32.7% of BCs (27% downstage, 5.7% upstage). Most (98.3%) of the downstaged BCs were estrogen receptor (ER)+/progesterone receptor (PR)+, whereas 78% of the upstaged BCs were ER−/PR−/human epidermal growth factor receptor 2 (HER2)−. Compared to TNM + Biomarkers staging, the addition of genetic profile data (TNM + Biomarker+RS <11) downstaged only <1% BCs. Our analysis suggests that for T1‐T2N0 ER+/HER2− BCs, Oncotype Dx™ RS <11 provides added value as a staging parameter only in a very small group of cases compared to TNM + Biomarkers alone.

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Changes of breast cancer staging when AJCC prognostic staging manual is used: a retrospective analysis of a Chinese cohort

Cited by 4 publications

References 22 publications

Validation of the Prognostic Stage from the American Joint Committee on Cancer 8th Staging Manual in Luminal B-Like Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer

Validation of the Prognostic Stage from the American Joint Committee on Cancer 8th Staging Manual in Luminal B-Like Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer

Genomic Profiling Comparison of Germline BRCA and Non-BRCA Carriers Reveals CCNE1 Amplification as a Risk Factor for Non-BRCA Carriers in Patients With Triple-Negative Breast Cancer

Impact of biomarkers and genetic profiling on breast cancer prognostication: A comparative analysis of the 8th edition of breast cancer staging system

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