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


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.


Breast neoplasms Prognostic stage Prognosis AJCC 8th edition 



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.


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.


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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

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