J Breast Cancer.  2019 Jun;22(2):260-273. 10.4048/jbc.2019.22.e16.

Validation of a Risk Score Incorporating Tumor Characteristics into the American Joint Committee on Cancer Anatomic Stage for Breast Cancer

• Seow YH
• Wong RX
• Lim JH
• Lian W
• Yap YS
• Wong FY

• KMID: 2450120
• DOI: http://doi.org/10.4048/jbc.2019.22.e16

Abstract

PURPOSE
The American Joint Committee on Cancer 8th edition (AJCC8) prognostic stage (PS) was implemented January 1, 2018, but it is complex due to multiple permutations. A North American group proposed a simpler system using the anatomic stage with a risk score system (RSS) of 1 point each for grade 3 tumor and human epithelial growth factor receptor 2 (HER2) and estrogen receptor (ER) negativity. Here we aimed to evaluate this risk score system with our database of Asian breast cancer patients and compare it against the AJCC8 PS.
METHODS
Patients diagnosed with breast cancer stage I-IV in 2006-2012 were identified in the SingHealth Joint Breast Cancer Registry. Five-year breast cancer-specific survival (CSS) and overall survival (OS) were calculated for each anatomic stage according to the risk score and compared with the AJCC8 PS.
RESULTS
A total of 6,656 patients were analyzed. The median follow-up was 61 (interquartile range, 37-90) months. There was a high receipt of endocrine therapy (84.6% of ER+ patients), chemotherapy (84.3% of node-positive patients), and trastuzumab (86.0% of HER2+ patients). Within each anatomic stage, there were significant differences in survival in all sub-stages except IIIB. On multivariate analysis, the hazard ratio for negative ER was 1.74 (1.48-2.06), for negative HER2 was 1.49 (1.26-1.74), and for grade 3 was 1.84 (1.55-2.19). On multivariate analysis controlled for age, ethnicity, and receipt of chemotherapy, the RSS (Akaike information criterion [AIC] = 10,649.45; Harrell's Concordance Index [C] = 0.85) was not inferior to the AJCC8 PS (AIC = 10,726.65; C = 0.84) for CSS, nor was the RSS (AIC = 14,714.4; C = 0.82) inferior to the AJCC8 PS (AIC = 14,784.69; C = 0.81) for OS.
CONCLUSION
The RSS is comparable to the AJCC8 PS for a patient population receiving chemotherapy as well as endocrine- and HER2-targeted therapy and further stratifies stage IV patients.

Keyword

Biomarkers; Breast neoplasms; Neoplasm staging prognosis; Survival

MeSH Terms

Asian Continental Ancestry Group
Biomarkers
Breast Neoplasms*
Breast*
Drug Therapy
Estrogens
Follow-Up Studies
Humans
Joints*
Multivariate Analysis
Trastuzumab
Biomarkers
Estrogens
Trastuzumab

Figure

• 

  Figure 1 Five-year CSS according to stage (I–IV) stratified by risk score. (a) I, (b) IIA, (c) IIB, (d) IIIA, (e) IIIB, (f) IIIC, (g) IV. CSS = cancer-specific survival.

• 

  Figure 2 Five-year OS according to stage (I–IV) stratified by risk score. (a) I, (b) IIA, (c) IIB, (d) IIIA, (e) IIIB, (f) IIIC, (g) IV. OS = overall survival.

• 

  Figure 3 Hazard ratios of breast cancer patients according to stage and risk score. Reference group was stage I risk 0; bars represent 95% confidence intervals. Data are adjusted for age, ethnicity, and chemotherapy. CSS = cancer-specific survival; OS = overall survival.

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