J Breast Cancer.  2018 Jun;21(2):173-181. 10.4048/jbc.2018.21.2.173.

Prognostic Validation of the American Joint Committee on Cancer 8th Staging System in 24,014 Korean Patients with Breast Cancer

• Kim I
• Choi HJ
• Ryu JM
• Lee SK
• Yu JH
• Kim SW
• Nam SJ
• Lee JE

• KMID: 2413936
• DOI: http://doi.org/10.4048/jbc.2018.21.2.173

Abstract

PURPOSE
The American Joint Committee on Cancer (AJCC) recently released the breast cancer staging system, 8th edition, which included additional four biologic factors. However, there has been no external validation of the prognostic value of the new stages with different population-based databases.
METHODS
To validate the prognostic value of the new staging system in the Asian population, with a focus on Korean patients with breast cancer, we performed a retrospective study with data from the Korean Breast Cancer Society that included 24,014 patients with invasive ductal or lobular carcinoma who underwent surgery between January 2009 and January 2012 in Korea. The proportional differences were evaluated between the anatomic staging system (AJCC 7th edition) and the prognostic staging system (AJCC 8th edition, December 2017 published version). Comparisons of overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier graphs and hazard ratios were also performed.
RESULTS
Our analysis included 24,014 patients (median age, 50 years; range, 20-91 years). Stage I, II, and III disease accounted for 47.6%, 43.5%, and 8.9%, respectively, of anatomic stages and 61.8%, 27.6%, and 10.8%, respectively, of clinical prognostic stages. A total of 6,272 cases (26.1%) were upstaged, 4,656 (19.4%) were downstaged, and 13,086 (54.5%) remained unchanged. OS and DFS decreased in the order from prognostic stages IA to IIIC but did not change among the anatomic stage groups.
CONCLUSION
Our data suggests that the prognostic staging system provides superior prognostic value to the anatomic staging system in Korean patients with breast cancer.

Keyword

Breast neoplasms; Neoplasm staging; Prognosis

MeSH Terms

Asian Continental Ancestry Group
Biological Factors
Breast Neoplasms*
Breast*
Carcinoma, Lobular
Disease-Free Survival
Humans
Joints*
Korea
Neoplasm Staging
Prognosis
Retrospective Studies
Biological Factors

Figure

• 

  Figure 1 Kaplan-Meier survival curves. (A) Overall survival according to anatomic stage, (B) disease-free survival according to anatomic stage, (C) overall survival accoding to clinical prognostic stage, (D) disease-free survival according to clinical prognostic stage.

• 

  Figure 2 Kaplan-Meier survival curves by pathologic prognostic stage in breast cancer patients excepting neoadjuvant chemotherapy treated patients. (A) Overall survival curve, (B) disease-free survival curve.

Reference

1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016; 66:7–30. PMID: 26742998.

2. Zhou B, Xu L, Ye J, Xin L, Duan X, Liu Y. The prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system in HER2-enriched subtype breast cancer, a retrospective analysis. Anticancer Res. 2017; 37:4615–4621. PMID: 28739761.

3. Singletary SE, Connolly JL. Breast cancer staging: working with the sixth edition of the AJCC cancer staging manual. CA Cancer J Clin. 2006; 56:37–47. PMID: 16449185.

4. Sobin LH, Gospodarowicz MK, Wittekind C. TNM Classification of Malignant Tumours. 7th ed. Chichester: John Wiley & Sons;2011.

5. Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, et al. Breast cancer: major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017; 67:290–303. PMID: 28294295.

6. Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, et al. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin. 2017; 67:93–99. PMID: 28094848.

7. American Joint Committee on Cancer. Cancer staging manual: updated breast chapter for 8th edition. Accessed July 1st, 2017. https://cancerstaging.org/references-tools/deskreferences/Pages/Breast-Cancer-Staging.aspx.

8. Laesser C, Beritelli P. St. Gallen consensus on destination management. J Destin Mark Manag. 2013; 2:46–49.

9. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17:1471–1474. PMID: 20180029.

10. Park YH, Lee SJ, Cho EY, Choi YL, Lee JE, Nam SJ, et al. Clinical relevance of TNM staging system according to breast cancer subtypes. Ann Oncol. 2011; 22:1554–1560. PMID: 21242587.

11. Caudle AS, Yu TK, Tucker SL, Bedrosian I, Litton JK, Gonzalez-Angulo AM, et al. Local-regional control according to surrogate markers of breast cancer subtypes and response to neoadjuvant chemotherapy in breast cancer patients undergoing breast conserving therapy. Breast Cancer Res. 2012; 14:R83. PMID: 22621334.

12. Mazouni C, Rimareix F, Mathieu MC, Uzan C, Bourgier C, André F, et al. Outcome in breast molecular subtypes according to nodal status and surgical procedures. Am J Surg. 2013; 205:662–667. PMID: 23312273.

13. Harris L, Fritsche H, Mennel R, Norton L, Ravdin P, Taube S, et al. American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol. 2007; 25:5287–5312. PMID: 17954709.

14. Arvold ND, Taghian AG, Niemierko A, Abi Raad RF, Sreedhara M, Nguyen PL, et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol. 2011; 29:3885–3891. PMID: 21900114.

15. Hu H, Wei W, Yi X, Xin L, Liu Y. A retrospective analysis of clinical utility of AJCC 8th edition cancer staging system for breast cancer. World J Oncol. 2017; 8:71–75. PMID: 29147438.

16. Weiss A, Mac Gregor MC, Lichtensztajn D, Yi M, Clarke CA, Giordano SH, et al. Validation of the AJCC 8th edition prognostic stage in breast cancer. J Clin Oncol. 2017; 35(15 Suppl):e23186.

17. Abdel-Rahman O. Assessment of the prognostic and discriminating value of the novel bioscore system for breast cancer: a SEER database analysis. Breast Cancer Res Treat. 2017; 164:231–236. PMID: 28417332.

18. Lee SB, Sohn G, Kim J, Chung IY, Lee JW, Kim HJ, et al. A retrospective prognostic evaluation analysis using the 8th edition of the American Joint Committee on Cancer staging system for breast cancer. Breast Cancer Res Treat. 2018; 169:257–266. PMID: 29388016.

19. Winchester DJ. Important changes made in the AJCC Cancer Staging Manual, Eighth Edition. Bulletin of the American College of Surgeons;Accessed July 1st, 2017. http://bulletin.facs.org/2017/01/important-changes-made-in-the-ajcc-cancer-staging-manual-eighth-edition/.

20. Feldman LD, Hortobagyi GN, Buzdar AU, Ames FC, Blumenschein GR. Pathological assessment of response to induction chemotherapy in breast cancer. Cancer Res. 1986; 46:2578–2581. PMID: 3697997.

21. Carey LA, Metzger R, Dees EC, Collichio F, Sartor CI, Ollila DW, et al. American Joint Committee on Cancer tumor-node-metastasis stage after neoadjuvant chemotherapy and breast cancer outcome. J Natl Cancer Inst. 2005; 97:1137–1142. PMID: 16077072.