Skip to main content
Erschienen in:

02.06.2024 | Breast Oncology

Validation of the AJCC 8th Edition Breast Cancer Prognostic Staging System in Legacy Alliance Trials (AFT-01)

verfasst von: Laura K. Krecko, MD, Heather B. Neuman, MD, MS, Caprice C. Greenberg, MD, MPH, Lee G. Wilke, MD, Bret M. Hanlon, PhD, Stephen B. Edge, MD, Kathryn J. Ruddy, MD, MPH, Ann H. Partridge, MD, MPH, Jennifer Le-Rademacher, PhD, Dou-Yan Yang, PhD, Jeffrey Havlena, MS, Jessica R. Schumacher, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 9/2024

Einloggen, um Zugang zu erhalten

Abstract

Background

The 8th edition American Joint Committee on Cancer staging system combined anatomic stage (AS) with receptor status and grade to create prognostic stage (PS). PS has been validated in single-institution and cancer registry studies; however, missing human epidermal growth factor receptor 2 (HER2) status and variable treatment and follow-up create limitations.

Objective

Our objective was to compare the relative prognostic ability of PS versus AS to predict survival using breast cancer clinical trial data.

Methods

Women with non-metastatic breast cancer enrolled in six Alliance for Clinical Trials in Oncology trials were included (enrollment years 1997–2010). AS and PS were constructed using pathological tumor size, nodal status, estrogen receptor (ER), progesterone receptor (PR), HER2 status, and grade. Unadjusted Cox proportional hazard models were estimated to predict overall survival within 5 years, with AS and PS as predictor variables. The relative predictive power of staging models was assessed by comparing Harrell concordance indices (C-indices). Kaplan–Meier-based mortality estimates were compared by stage.

Results

Overall, 6924 women were included (median age 53 years); 45.2% were diagnosed with ER+/PR+/HER2− tumors, 26.2% with HER2+ tumors, and 17.1% with ER−/PR−/HER2− tumors. Median follow-up time was 5 years (interquartile range 2.95–5.00). PS significantly improved predictive performance (C-index 0.721) for overall survival compared with AS (0.700) (p = 0.020). Kaplan–Meier hazard estimates suggested PS did not distinguish mortality risk between patients with IIB and IIIA or IB and IIA disease.

Conclusions

PS has significantly improved predictive performance for OS compared with AS. As systemic therapies evolve, it will be important to re-evaluate the prognostic staging system, particularly for patients with intermediate-stage cancers.
ClinicalTrials.gov Identifier: NCT02171078
Anhänge
Nur mit Berechtigung zugänglich
Literatur
4.
Zurück zum Zitat American Joint Committee on Cancer. AJCC Cancer Staging Manual, Eighth Edition. Springer International Publishing; 2017. American Joint Committee on Cancer. AJCC Cancer Staging Manual, Eighth Edition. Springer International Publishing; 2017.
9.
Zurück zum Zitat Li X, Zhang Y, Meisel J, Jiang R, Behera M, Peng L. Validation of the newly proposed American Joint Committee on Cancer (AJCC) breast cancer prognostic staging group and proposing a new staging system using the National Cancer Database. Breast Cancer Res Treat. 2018;171(2):303–13. https://doi.org/10.1007/s10549-018-4832-9.CrossRef Li X, Zhang Y, Meisel J, Jiang R, Behera M, Peng L. Validation of the newly proposed American Joint Committee on Cancer (AJCC) breast cancer prognostic staging group and proposing a new staging system using the National Cancer Database. Breast Cancer Res Treat. 2018;171(2):303–13. https://​doi.​org/​10.​1007/​s10549-018-4832-9.CrossRef
23.
Zurück zum Zitat Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247(18):2543–6.CrossRef Harrell FE Jr, Califf RM, Pryor DB, Lee KL, Rosati RA. Evaluating the yield of medical tests. JAMA. 1982;247(18):2543–6.CrossRef
24.
Zurück zum Zitat Newson RB. Comparing the Predictive Powers of Survival Models Using Harrell’s C or Somers’ D. The Stata Journal. 2010;10:339–58.CrossRef Newson RB. Comparing the Predictive Powers of Survival Models Using Harrell’s C or Somers’ D. The Stata Journal. 2010;10:339–58.CrossRef
26.
Zurück zum Zitat He J, Tsang JY, Xu X, et al. AJCC 8th edition prognostic staging provides no better discriminatory ability in prognosis than anatomical staging in triple negative breast cancer. BMC Cancer. 2020;20(18):1–9. He J, Tsang JY, Xu X, et al. AJCC 8th edition prognostic staging provides no better discriminatory ability in prognosis than anatomical staging in triple negative breast cancer. BMC Cancer. 2020;20(18):1–9.
28.
Zurück zum Zitat Wang M, Wu K, Zhang P, Zhang M, Ding A, Chen H. The Prognostic Significance of the Oncotype DX Recurrence Score in T(1–2)N(1)M(0) Estrogen Receptor-Positive HER2-Negative Breast Cancer Based on the Prognostic Stage in the Updated AJCC 8th edition. Ann Surg Oncol. 2019;26(5):1227–35. https://doi.org/10.1245/s10434-018-7068-3.CrossRef Wang M, Wu K, Zhang P, Zhang M, Ding A, Chen H. The Prognostic Significance of the Oncotype DX Recurrence Score in T(1–2)N(1)M(0) Estrogen Receptor-Positive HER2-Negative Breast Cancer Based on the Prognostic Stage in the Updated AJCC 8th edition. Ann Surg Oncol. 2019;26(5):1227–35. https://​doi.​org/​10.​1245/​s10434-018-7068-3.CrossRef
Metadaten
Titel
Validation of the AJCC 8th Edition Breast Cancer Prognostic Staging System in Legacy Alliance Trials (AFT-01)
verfasst von
Laura K. Krecko, MD
Heather B. Neuman, MD, MS
Caprice C. Greenberg, MD, MPH
Lee G. Wilke, MD
Bret M. Hanlon, PhD
Stephen B. Edge, MD
Kathryn J. Ruddy, MD, MPH
Ann H. Partridge, MD, MPH
Jennifer Le-Rademacher, PhD
Dou-Yan Yang, PhD
Jeffrey Havlena, MS
Jessica R. Schumacher, PhD
Publikationsdatum
02.06.2024
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 9/2024
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15477-5

Neu im Fachgebiet Chirurgie

Appendizitis und Darminfarkt durch Blinddarm-Lipom

Eigentlich sind Lipome recht harmlos. Im Zäkum können sie jedoch erhebliche Komplikationen mit Darminfarkt und Appendizitis verursachen.

Gluteuslappen nach Rektumkarzinom-Op. schützt vor Abszessen

Die Wunddeckung mit einem autologen Rotationslappen nach Entfernung eines Rektumkarzinoms konnte in einer randomisierten Studie gegenüber dem primären Wundverschluss vor allem in einer Hinsicht punkten: Sie führte deutlich seltener zu präsakralen Abszessen.

Antibiotika bei Erwachsenen mit Appendizitis oft ausreichend

Bei etwa zwei Drittel aller Erwachsenen mit akuter Appendizitis könnte eine antibiotische Behandlung ausreichen, wie eine Metaanalyse nahelegt. Die Komplikationsrate war insgesamt gering, auch wenn letztlich doch eine Op. fällig wurde.

Katheterablation bei Vorhofflimmern: Ist frühe Intervention von Vorteil?

Bei Patienten mit Vorhofflimmern scheinen die Therapieergebnisse bezüglich Rezidivfreiheit bei frühzeitiger Katheterablation besser zu sein als bei später erfolgter Ablation. Dafür sprechen Ergebnisse einer aktuellen Registeranalyse. 

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.