Validation of the 8th AJCC prognostic staging system for breast cancer in a population-based setting

Abdel‐Rahman, Omar

doi:10.1007/s10549-017-4577-x

Cited by 71 publications

(67 citation statements)

References 16 publications

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“…To provide more accurate prognostic information for BC patients, the novel prognostic staging system was proposed by AJCC in October 2016, in which ER, PR, Her‐2, and histological grade were incorporated into the anatomic TNM staging . To date, the validity of the prognostic staging system has been validated in some studies . Weiss et al demonstrated that the new prognostic staging had a higher Harrell concordance index(C index) and lower Akaike information criterion (AIC) value, which mean better prognostic performance than the anatomic TNM staging alone .…”

Section: Discussionmentioning

confidence: 99%

“…Since the novel staging system for BC was proposed by AJCC, its prognostic value and availability have been validated in BC patients . However, the prognostic staging system seems to be somewhat complex and not convenient for clinical application due to the redundant grouping.…”

Section: Introductionmentioning

confidence: 99%

“…14 Since the novel staging system for BC was proposed by AJCC, its prognostic value and availability have been validated in BC patients. [15][16][17][18] However, the prognostic staging system seems to be somewhat complex and not convenient for clinical application due to the redundant grouping. Recently, some scholars proposed a new bioscore system, in which different risk points were assigned to each independent prognostic factor according to the magnitude of HR in the Cox proportional hazard model.…”

Section: Introductionmentioning

confidence: 99%

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The assessment of 8th edition AJCC prognostic staging system and a simplified staging system for breast cancer: The analytic results from the SEER database

2019

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The prognostic value of the prognostic staging system that incorporated estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor‐2 (Her‐2), and histological grade has been validated in breast cancer (BC) patients, but the staging system seems to be somewhat complex. Recently, an updated bioscore system based on these tumor biological factors was proposed. The purpose of this study was to compare the prognostic stratification between prognostic staging system of American Joint Commission on Cancer (AJCC) and a simplified staging system based on the bioscore system and anatomic TNM staging for BC patients. A total of 44 593 patients with invasive ductal carcinoma who underwent radical resection between 2010 and 2011 were reviewed using the SEER database. The patients were reclassified into different groups according to the anatomic staging system, prognostic staging system, risk bioscore system, and simplified staging system, respectively. The prognostic differences between different groups were compared and clinicopathologic features were analyzed. The anatomic TNM staging failed to clearly distinguish the prognostic difference between stage IIIB and stage IIIC. Therefore, we proposed an adjusted anatomic staging, in which T1N3 and T2N3 were downstaged from stage IIIC to stage IIIB, and T4N2 was upstaged from stage IIIB to stage IIIC. Histological grade III, ER(−), PR(−), and Her‐2(−) were identified as independent prognostic factors in the multivariate analysis, and these factors were separately marked as 1 point. There were significant survival differences among different risk points except for the comparison between 0 and 1 point. The higher the risk points, the poorer the prognosis of BC patients. In addition, the curve distance between stage IIA and stage IIB was not significantly broaden according to the prognostic staging system. However, the prognostic stratification for BC patients could be significantly improved by the simplified staging system incorporated the bioscore system and adjusted anatomic staging. Several drawbacks may still exist in the prognostic staging system of AJCC. A simplified staging system that incorporated risk score system and the anatomic staging could provide more accurate prognostic information for BC patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The assessment of 8th edition AJCC prognostic staging system and a simplified staging system for breast cancer: The analytic results from the SEER database

2019

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“…Several retrospective studies were undertaken to validate the AJCC eighth edition PS and had present concrete evidence of the advantages of PS in refining stratification and prognostic information . For instance, Weis et al reviewed a total of 3,327 patients with stage I to IIIC breast cancer treated between 2007 and 2013 at MD Anderson Cancer Center and identified a total of 54,727 patients with stage I to IV breast cancer treated between 2005 and 2009 in the California Cancer Registry .…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, the prognostic staging system in conjunction with RS has not yet been validated in any study. The prognostic staging system has been validated in prior series, but those studies did not focus on the incorporation of RS . Moreover, few studies performed the validation and comparison among the three staging systems to determine the most useful classification criteria for patients.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Incorporation of Recurrence Score into the American Joint Committee on Cancer Eighth Edition Staging System in Patients with T1-2N0M0, Estrogen Receptor-Positive, Human Epidermal Growth Receptor 2-Negative Invasive Breast Cancer: A Population-Based Analysis

Ding

Lin

et al. 2019

The Oncologist

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Background The current study aimed to evaluate the predictive performance of the American Joint Committee on Cancer eighth edition staging system in patients with invasive breast cancer based on the Surveillance, Epidemiology, and End Results database. Subjects, Materials, and Methods Patients diagnosed with T1‐2N0M0, estrogen receptor‐positive, human epidermal growth factor receptor 2‐negative breast cancer from 2010 to 2014 were retrospectively recruited in this analysis. Patients were reassigned to different stages according to the anatomic staging system (AS), prognostic staging system (PS), and prognostic and genomic staging criteria downstaging patients with recurrence score (RS) lower than 11 (PGS_RS11). Cox models were conducted for multivariate analyses, and likelihood ratio (LR) χ2, Akaike information criterion (AIC), and Harrell's concordance index (C‐index) were calculated for the comparison of different staging systems. Additionally, adjustments were made to generate prognostic and genomic staging criteria downstaging patients with RS lower than 18 (PGS_RS18) and RS lower than 25 (PGS_RS25). Results PGS_RS11 was an independent predictor for breast cancer‐specific survival, as were PS and AS. Adjusted for age and ethnicity, PGS_RS11 (AIC = 2,322.763, C‐index = 0.7482, LR χ2 = 113.17) showed superiority in predicting survival outcomes and discriminating patients compared with AS (AIC = 2,369.132, C‐index = 0.6986, LR χ2 = 60.80) but didn't outperform PS (AIC = 2,320.992, C‐index = 0.7487, LR χ2 = 114.94). The predictive and discriminative ability of PGS_RS18 was the best (AIC = 2297.434, C‐index = 0.7828, LR χ2 = 138.50) when compared with PS and PGS_RS11. Conclusion PGS_RS11 was superior to AS but comparable with PS in predicting prognosis. Further validations and refinements are needed for the better incorporation of RS into staging systems. Implications for Practice Staging systems are of critical importance in informing prognosis and guiding treatment. This study's objective was to evaluate the newly proposed staging system in the American Joint Committee on Cancer eighth edition staging manual, which combined biological and genomic information with the traditional TNM classification for the first time to determine tumor stages of breast cancer. The superiority of the prognostic and genomic staging system was validated in our cohort and possibly could encourage the utility of genomic assays in clinical practice for staging assessment and prognosis prediction.

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Impact of postoperative radiotherapy on the outcomes of resected adrenocortical carcinoma—a real-world, population-based study

Abdel‐Rahman

2021

Strahlenther Onkol

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Validation of the 8th AJCC prognostic staging system for breast cancer in a population-based setting

Abstract: The current analysis showed an improvement in the discriminatory value for the prognostic staging system compared to the anatomical staging system and endorsed its routine use in clinical practice.

Cited by 71 publications

References 16 publications

The assessment of 8th edition AJCC prognostic staging system and a simplified staging system for breast cancer: The analytic results from the SEER database

The assessment of 8th edition AJCC prognostic staging system and a simplified staging system for breast cancer: The analytic results from the SEER database

Evaluation of the Incorporation of Recurrence Score into the American Joint Committee on Cancer Eighth Edition Staging System in Patients with T1-2N0M0, Estrogen Receptor-Positive, Human Epidermal Growth Receptor 2-Negative Invasive Breast Cancer: A Population-Based Analysis

Impact of postoperative radiotherapy on the outcomes of resected adrenocortical carcinoma—a real-world, population-based study

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