Validation of the AJCC 8th prognostic system for breast cancer in an Asian healthcare setting

Wong, Ru Xin; Wong, Fuh Yong; Lim, John; Lian, Weixiang; Yap, Yoon Sim

doi:10.1016/j.breast.2018.04.013

Cited by 22 publications

(21 citation statements)

References 21 publications

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“…Then, the revised 8th edition of AJCC cancer staging was applied in December 2017 [5]. Up to now, various studies in different clinical settings have validated that the PS system provides better prognostic information than the AS system [6][7][8][9][10][11][12][18][19][20][21]. The rates of staging changes (upstage/downstage) from AS to PS ranged from 41% to 68.8%, because of different single/ multi institution study, different sample, different race and age and different subtype proportions.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in triple-negative breast cancer

Zhang

et al. 2019

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The American Joint Committee on Cancer (AJCC) released its 8th edition of cancer staging implemented in early 2018. This study aims to compare anatomic staging (AS) with prognostic staging (PS) based on the updated AJCC 8th edition staging manual. A retrospective single-center analysis of 313 triple-negative breast invasive ductal carcinoma patients who received surgery at department of breast surgery in the Fourth Hospital of Hebei Medical University from 01/2010-12/2012 was performed. All cases were restaged using the AJCC 8th edition AS and PS system. The 7-year disease-free survival (DFS) and the 7-year overall survival (OS) rates were 76.30% and 78.27%, respectively. Applying the PS system, 277 (88.5%) patients of the AS groups were upstaged to the PS groups, 31 cases with IIIC and 5 cases with IV unchanged (11.5%) and no cases downstaged. Both 7-year DFS and 7-year OS were significantly different in the different AS and PS groups (all, p<0.001). The PS system was found to provide better prognostic information in patients with AS group IIB. A total of 43 patients with AS group IIB were upstaged by PS system, in which 30 patients were +2 upstaged to PS IIIB, and 13 patients were +3 upstaged to PS IIIC. PS IIIB and IIIC from AS IIB had significant differences in 7-year DFS (χ 2 =5.628, p=0.014) and 7-year OS (χ 2 =6.037, p=0.018). Both AS and PS systems proposed in the 8th edition of the AJCC breast cancer staging manual had prognostic value in TNBC. Moreover, the PS system predicts clinical outcomes of TNBC patients more accurately than the traditional AS system.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in triple-negative breast cancer

Zhang

et al. 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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“…PS takes account of major recent advances in our understanding of BC at cellular level and more accurately predicts patient outcome [31-35]. A recent study of deceased patients found that PS separated patients according to overall survival time [36].…”

Section: Discussionmentioning

confidence: 99%

The American Joint Commission Cancer 8th Edition Prognostic Stage Including Oncotype DX® Recurrence Score: Impact on Staging of Early Breast Cancer

et al. 2018

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Background: The American Joint Commission Cancer (AJCC) Cancer Staging Manual 8th edition introduced a breast cancer (BC) Prognostic Stage (PS) that combines tumour grade, oestrogen (ER), progesterone (PgR), and human epidermal growth factor-2 (HER2) receptor status with Anatomic TNM Stage (AS). In a further modification, patients with early BC and an Oncotype DX® Recurrence Score (RS) < 11 are assigned to PS 1A irrespective of grade and size up to 5 cm. This study profiles the impact of these changes on staging in patients with early BC and RS < 11. Methods: A total of 127 patients, with primary BC and RS < 11, were identified from a consecutive series of 729 patients with ER-positive, HER2-negative, lymph node-negative, primary BC whose tumours were tested using the Oncotype DX® 21 multigene assay. Each patient was assigned AS, PS, and RS-modified PS, and staging categories were compared. Results: Applying AS, 100 patients were stage IA and 27 IIA. Applying PS, 89 were stage IA, 33 IB, 4 IIA, and 1 IIB. All patients were IA according to RS-modified PS. Comparing PS to AS, 26.7% of patients (n = 34) changed stage, 9.4% (n = 12) to a higher and 17.3% (n = 22) to a lower stage. RS-modified PS versus AS resulted in downstaging in 21.3% (n = 27). Comparing PS modified by RS to PS alone, 29.9% (n = 38) were downstaged. Conclusion: Application of PS and RS-modified PS results in tumour downstaging in approximately 20% of patients with early BC. Upstaging was observed in 9% of patients when staged according to PS and was primarily due to the impact of high histological grade.

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Validation of the AJCC 8th prognostic system for breast cancer in an Asian healthcare setting

Cited by 22 publications

References 21 publications

The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in triple-negative breast cancer

The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in triple-negative breast cancer

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

The American Joint Commission Cancer 8th Edition Prognostic Stage Including Oncotype DX® Recurrence Score: Impact on Staging of Early Breast Cancer

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