Advertisement

Virchows Archiv

, Volume 474, Issue 2, pp 193–200 | Cite as

Validation of the pathological prognostic staging system proposed in the revised eighth edition of the AJCC staging manual in different molecular subtypes of breast cancer

  • Nuri Jang
  • Jung Eun Choi
  • Su Hwan Kang
  • Young Kyung BaeEmail author
Original Article
  • 136 Downloads

Abstract

The authors investigated the clinical utility of the revised prognostic staging system proposed in the eighth edition of the American Joint Committee on Cancer (AJCC) staging manual in breast cancer (BC) patients. We retrospectively reviewed the data of 714 BC patients that received surgical treatment and standard adjuvant therapy from January 2005 to December 2007. All patients were restaged for anatomic TNM stage and pathological prognostic (PP) stage as defined in the revised eighth edition of the AJCC manual. Compared with anatomic stage, PP stage was different from anatomic stage in 325 (45.5%) patients, 254 were down-staged and 71 were upstaged. There were significant differences in overall survival (OS) and disease-free survival (DFS) according to different anatomic stages or PP stages (all, p < 0.001). In anatomic stage I patients, OS was significantly different between PP stages IA and IB (p < 0.001), but no significant difference was observed between anatomic stages IA and IB (p = 0.413). PP stages exhibited significant OS differences in anatomic stage IIB (p = 0.011), but survival differences according to PP stages were not observed in anatomic stage IIA, IIIA, or IIIC. PP stages were found to have prognostic value with respect to OS and DFS for luminal (p < 0.001 and p < 0.001), HER2-positive (p = 0.001 and p = 0.013), and triple-negative (p = 0.008 and p = 0.03) subtypes. The prognostic staging system proposed in the eighth edition of the AJCC more accurately predicts the clinical outcomes of BC patients than the traditional anatomic staging system.

Keywords

Breast neoplasms Prognostic stage Prognosis AJCC 8th edition 

Notes

Contributions

NJ collected the clinicopathological data, evaluated the H&E slides, analyzed the data, and wrote the manuscript. JEC took part in the study design, assisted in data collection, and edited the manuscript. SHK contributed to the study design and critically reviewed and edited the manuscript. YKB conceived the study, evaluated clinicopathological data and H&E slides, analyzed the data, and critically reviewed and revised the manuscript. All authors agreed with the submission in its present forms for publication.

Funding

This work was supported by Yeungnam University Research Grants in 2014 and 2017.

Compliance with ethical standards

This is a retrospective study involving patients’ medical records and H&E slides and has been approved by the Institutional Review Board of Yeungnam University Hospital (YUMC 2017-09-030), which waived the requirement for informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Brierley JD, Gospodarowicz MK, Wittekind C (eds) (2017) TNM classification of malignant tumours, 8th edn. John Wiley and Sons, ChichesterGoogle Scholar
  2. 2.
    Hortobagyi G, Connolly JL, D’Orsi CJ, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, Weaver DL, Winchester DJ, Giuliano A (2017) Breast. In: Amin MB, Edge SB, Greene FL et al (eds) AJCC cancer staging manual, 8th edn. Springer, New York, pp 587–628Google Scholar
  3. 3.
    Cserni G, Chmielik E, Cserni B, Tot T (2018) The new TNM-based staging of breast cancer. Virchows Arch 472:697–703CrossRefGoogle Scholar
  4. 4.
    Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, Weaver DL, Winchester DJ, Hortobagyi GN (2017) Breast cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin 67:290–303CrossRefGoogle Scholar
  5. 5.
    Xu L, Li JH, Ye JM, Duan XN, Cheng YJ, Xin L, Liu Q, Zhou B, Liu YH (2017) A retrospective survival analysis of anatomic and prognostic stage group based on the American Joint Committee on Cancer 8th edition cancer staging manual in luminal B human epidermal growth factor receptor 2-negative breast cancer. Chin Med J 130:1945–1952CrossRefGoogle Scholar
  6. 6.
    Ibis K, Ozkurt S, Kucucuk S, Yavuz E, Saip P (2018) Comparison of pathological prognostic stage and anatomic stage groups according to the updated version of the American Joint Committee on Cancer (AJCC) breast Cancer staging 8th edition. Med Sci Monit 24:3637–3643CrossRefGoogle Scholar
  7. 7.
    Weiss A, Chavez-MacGregor M, Lichtensztajn DY, Yi M, Tadros A, Hortobagyi GN, Giordano SH, Hunt KK, Mittendorf EA (2018) Validation study of the American Joint Committee on Cancer eighth edition prognostic stage compared with the anatomic stage in breast cancer. JAMA Oncol 4:203–209CrossRefGoogle Scholar
  8. 8.
    Wang M, Chen H, Wu K, Ding A, Zhang M, Zhang P (2018) Evaluation of the prognostic stage in the 8th edition of the American Joint Committee on Cancer in locally advanced breast cancer: an analysis based on SEER 18 database. Breast 37:56–63CrossRefGoogle Scholar
  9. 9.
    American Joint Committee on Cancer (2018) Updated breast chapter for 8th edition. https://cancerstaging.org/references-tools/deskreferences/Pages/Breast-Cancer-Staging.aspx. Accessed 25 January 2018
  10. 10.
    Bae YK, Gong G, Kang J, Lee A, Cho EY, Lee JS, Suh KS, Lee DW (2012) Hormone receptor expression in invasive breast cancer among Korean women and comparison of 3 antiestrogen receptor antibodies: a multi-institutional retrospective study using tissue microarrays. Am J Surg Pathol 36:1817–1825CrossRefGoogle Scholar
  11. 11.
    Bae YK, Gong G, Kang J, Lee A, Cho EY, Lee JS, Suh KS, Lee DW, Jung WH, Breast Pathology Study Group of Korean Society of Pathologists (2012) HER2 status by standardized immunohistochemistry and silver-enhanced in situ hybridization in Korean breast cancer. J Breast Cancer 15:381–387CrossRefGoogle Scholar
  12. 12.
    Byeon SJ (2017) Current status of pathologic examinations in Korea, 2011-2015, based on the Health Insurance Review and Assessment Service dataset. J Pathol Transl Med 51:137–147CrossRefGoogle Scholar
  13. 13.
    Kwon HJ, Choi JE, Kang SH, Son Y, Bae YK (2017) Prognostic significance of CD9 expression differs between tumor cells and stromal immune cells and depends on the molecular subtype of the invasive breast carcinoma. Histopathology 70:1155–1165CrossRefGoogle Scholar
  14. 14.
    Elston CW, Ellis IO (2002) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. C. W. Elston & I. O. Ellis. Histopathology 1991; 19; 403–410. Histopathology 41:151–152 discussion 152–3CrossRefGoogle Scholar
  15. 15.
    Goldhirsch A, Winer EP, Coates AS, Gelber RD, Piccart-Gebhart M, Thurlimann B, Senn HJ, Panel members (2013) Personalizing the treatment of women with early breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2013. Ann Oncol 24:2206–2223CrossRefGoogle Scholar
  16. 16.
    Schwartz AM, Henson DE, Chen D, Rajamarthandan S (2014) Histologic grade remains a prognostic factor for breast cancer regardless of the number of positive lymph nodes and tumor size: a study of 161 708 cases of breast cancer from the SEER Program. Arch Pathol Lab Med 138:1048–1052CrossRefGoogle Scholar
  17. 17.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG), Davies C, Godwin J, Gray R, Clarke M, Cutter D, Darby S, McGale P, Pan HC, Taylor C, Wang YC, Dowsett M, Ingle J, Peto R (2011) Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials. Lancet 378:771–784CrossRefGoogle Scholar
  18. 18.
    Bae SY, Kim S, Lee JH, Lee HC, Lee SK, Kil WH, Kim SW, Lee JE, Nam SJ (2015) Poor prognosis of single hormone receptor- positive breast cancer: similar outcome as triple-negative breast cancer. BMC Cancer 15:138CrossRefGoogle Scholar
  19. 19.
    Slamon DJ, Leyland-Jones B, Shak S, Fuchs H, Paton V, Bajamonde A, Fleming T, Eiermann W, Wolter J, Pegram M, Baselga J, Norton L (2001) Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2. N Engl J Med 344:783–792CrossRefGoogle Scholar
  20. 20.
    Ross JS, Slodkowska EA, Symmans WF, Pusztai L, Ravdin PM, Hortobagyi GN (2009) The HER-2 receptor and breast cancer: ten years of targeted anti-HER-2 therapy and personalized medicine. Oncologist 14:320–368CrossRefGoogle Scholar
  21. 21.
    Goldhirsch A, Wood WC, Coates AS, Gelber RD, Thurlimann B, Senn HJ, Panel members (2011) Strategies for subtypes--dealing with the diversity of breast cancer: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol 22:1736–1747CrossRefGoogle Scholar
  22. 22.
    Lee SB, Sohn G, Kim J, Chung IY, Lee JW, Kim HJ, Ko BS, Son BH, Ahn SH (2018) 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 169:257–266CrossRefGoogle Scholar
  23. 23.
    Kim JY, Lim JE, Jung HH, Cho SY, Cho EY, Lee SK, Yu JH, Lee JE, Kim SW, Nam SJ, Park YH, Ahn JS, Im YH (2018) Validation of the new AJCC eighth edition of the TNM classification for breast cancer with a single-center breast cancer cohort. Breast Cancer Res TreatGoogle Scholar
  24. 24.
    Abdel-Rahman O (2018) Validation of the 8th AJCC prognostic staging system for breast cancer in a population-based setting. Breast Cancer Res Treat 168:269–275CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PathologyYeungnam University College of MedicineDaeguSouth Korea
  2. 2.Department of SurgeryYeungnam University College of MedicineDaeguSouth Korea

Personalised recommendations