J Breast Cancer.  2020 Feb;23(1):59-68. 10.4048/jbc.2020.23.e9.

Assessment of the Prognostic Staging System of American Joint Committee on Cancer 8th Edition for Breast Cancer: Comparisons with the Conventional Anatomic Staging System

• Kim EJ
• Park HS
• Kim JY
• Kim SI
• Cho YU
• Park BW

• KMID: 2470882
• DOI: http://doi.org/10.4048/jbc.2020.23.e9

Abstract

PURPOSE
The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual introduced a new prognostic staging system for breast cancer. This study aimed to evaluate the changes in staging distribution and predictive power of the new staging system.
METHODS
Of the 12,275 patients with breast cancer identified from the Severance Breast Cancer Registry who underwent surgery between 1978 and 2016, 12,125 patients met the inclusion criteria.
RESULTS
In both the 7th and 8th staging systems, stage I patients constituted the largest proportion (38.2% and 48.4%). Migration from the 7th to 8th edition of the AJCC manual resulted in a decrease in stage II population and an increase in stage I and III populations. A total of 1,293 (15.4%) patients were upstaged, and 1,201 (14.3%) were downstaged. Downstaged patients had better recurrence-free and overall survival (p < 0.001). Pathologic complete response after neoadjuvant therapy showed good prognosis as p stage 0, and yp stages I and III showed poorer outcomes than the same p stage (p < 0.001).
CONCLUSIONS
Staging migrations are common in early breast cancer under the prognostic staging system. The prognostic staging system of the 8th edition of the AJCC manual discriminates survival outcomes better than the anatomical staging system of the 7th edition of the AJCC manual.

Keyword

Breast neoplasms; Prognostic staging

MeSH Terms

Breast Neoplasms*
Breast*
Humans
Joints*
Neoadjuvant Therapy
Prognosis

Figure

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  Figure 1 Flow diagram of study cohort. AJCC = American Joint Committee on Cancer; HER2 = human epidermal growth factor receptor 2; ER = estrogen receptor; PR = progesterone receptor.

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  Figure 2 Stage migration of study population. AJCC = American Joint Committee on Cancer; LCIS = lobular carcinoma in situ as a benign entity.

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  Figure 3 Changes of RFS (A-C) and OS (D-F) according to migration of anatomic stage (A and D) I, (B and E) II, (C and F) III. An = anatomic stage according to AJCC 7th edition; Pr = prognostic stage according to AJCC 8th edition; AJCC = American Joint Committee on Cancer; RFS = recurrence-free survival; OS = overall survival.

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  Figure 4 Changes of OS according to NCT in each prognostic stage; (A) stage 0, (B) stage I, (C) stage II, (D) stage III, (E) stage IV. OS = overall survlval; NCT = neoadjuvant chemotherapy.

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