AJCC 8th edition prognostic staging provides no better discriminatory ability in prognosis than anatomical staging in triple negative breast cancer

Abstract

Background: We retrospectively compared the prognostic value between the AJCC 8th edition anatomic (AS) and prognostic staging (PS) system for triple negative breast cancer (TNBC) in a cohort from two involved institutions and a large population database. Methods: Clinicopathological data of TNBCs were identified in two involved institutions (SYSUCC-PWH cohort). Data from SEER database during 2010-2015 was also accessed. We restaged all cases into AS and PS group according to the AJCC 8th staging system. Results: A total of 611 and 31,941 TNBCs were identified in two cohorts, with a median follow-up of 53.5 and 27 months respectively. PS upstaged 46.1% of patients in SYSUCC-PWH cohort, and 62.4% in SEER cohort. No significant difference was observed in C index between AS and PS models for disease-specific survival (DSS), progression-free survival (PFS) or overall survival (OS) in either cohort. χ2 statistic and Hazard Ratio for PFS, DSS and OS showed better discrimination between IA and IB, IIB and IIIA, IIIA and IIIB in AS model than PS model. Besides, patients with IIIC unchanged stage showed worse PFS compared to those with AS IIIA or IIIB upstaged to PS IIIC in both cohorts(p = 0.049, p < 0.001). Conclusions: Our findings demonstrated that prognostic staging system did not provide better discriminatory ability in predicting TNBCs prognosis than anatomic staging system.

<p>Estrogen-Related Receptor α (ERRα) and G Protein-Coupled Estrogen Receptor (GPER) Synergistically Indicate Poor Prognosis in Patients with Triple-Negative Breast Cancer</p>

“…[1][2][3][4] Despite the development of novel clinical therapies in TNBCs, such as Poly-ADP-ribose polymerase inhibitors and immunotherapy, however, TNBC still demonstrates worse prognosis than non-TNBC, with a median OS of 28 months, approximately. 5,6 Recurrence and distant metastasis are the leading causes of mortality in patients with TNBC, 4,7,8 and recent studies suggest that younger patients with TNBC may have a higher incidence of recurrence or metastasis when compared with their older counterparts. However, the underlying mechanism is still unclear.…”

The comparison of the anatomic stage and pathological prognostic stage according to the AJCC 8th edition for the prognosis in Japanese breast cancer patients: data from a single institution

“…The impact of the prognostic stage on the prognosis seems to differ among subtypes and studies. Prognostic staging provides no better discriminatory ability concerning the prognosis than anatomical staging in the TN subtype [ 13 ]. In contrast, however, in HER2-positive breast cancer in the ShortHER trial, the utility of the prognostic stage was validated [ 14 ].…”

A Mathematical Model to Predict Diagnostic Periods for Secondary Distant Metastases in Patients with ER/PR/HER2/Ki-67 Subtypes of Breast Cancer

“…The TVDT is one of the most critical parameters used to develop the consolidated mathematical growth model of the PT and sdMTSs of BC (CoMPaS) and to calculate the earliest diagnostic period of sdMTSs in patients with BC [ 21 ]. The TVDT, which helped in the development of the mathematical growth model, is a combined quality indicator that reflects the subtype of BC, the proliferative activity, the degree of tumor differentiation, the Nottingham prognostic index (NPI) score, receptor activity (ER(+), ER(−), PR(+), PR(−), HER2(+), HER2(−), Ki-67), and triple-negative BC [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 ]. Hence, patients can obtain a personalized approach for building a schedule of multimodal examinations to detect sdMTSs at the early stage and to start early treatment that can increase the patient’s life [ 43 ].…”

“…The consolidated mathematical growth model (CoMPaS) and the corresponding software tool may be used for work with the eighth edition American Joint Committee on Cancer (AJCC) prognostic staging system for breast cancer [ 69 , 70 , 71 , 72 ].…”

“…If a patient has TVDT PT data, the consolidated mathematical growth model (CoMPaS) helps to calculate the data for the new personalized screening program of the sdMTS of breast cancer for each patient with T3N0-3M0 and the ER/PR/HER2/Ki-67 subtypes depending on the natural growth rate of the PT and MTS (the diagnostic periods of rapidly growing sdMTSs (HR(−)/HER2(−)—triple-negative tumors), intermediately growing sdMTSs (HR(−)/HER2(+)—HER2-positive tumors), intermediately growing sdMTSs (luminal B = HR(+)/HER2(−)), slowly growing sdMTSs (luminal B = HR(+)/HER2(+)), and very slowly growing sdMTSs (luminal A = HR(+)/HER2(−))) ( Figure 1 , Figure 2 , Figure 3 , Figure 4 , Figure 5 , Figure 6 , Figure 7 and Figure 8 ; Table 1 ) [ 22 , 23 , 69 , 70 , 71 , 72 , 101 , 102 , 103 , 104 , 105 , 106 ].…”