Evaluation of the 8th edition of the American joint committee on cancer’s pathological staging system in prognosis assessment and treatment decision making for stage T1-2N1 breast cancer after mastectomy

Abstract

Purpose The 8th edition of the American Joint Committee on Cancer (AJCC) pathological staging system for breast cancer considers biologic factors in addition to the anatomical features included in the previous systems. The purpose of this study was to determine the validity of the 8th AJCC staging system for T1-2N1 breast cancer and to assess the effect of additional chemotherapy and radiotherapy according to the new pathologic stages. Methods The cohort included patients from the Surveillance, Epidemiology, and End Results program (2010–2012) who had stage T1-2N1 invasive breast carcinoma and underwent mastectomy. All patients were restaged using the 8th AJCC staging system. The Kaplan–Meier method, Cox proportional hazards regression, and competing risks models were used for data analysis. Results We identified 9908 patients including 3022 (30.5%), 3131 (31.6%), 1940 (19.6%), 1194 (12.1%), and 621 (6.3%) were classified with stage IA, IB, IIA, IIB, and IIIA disease, respectively. The 5-year breast cancer-specific survival (BCSS) was 97.3%, 94.3%, 88.3%, 84.0%, and 71.1% for stage IA, IB, IIA, IIB, and IIIA disease, respectively. Higher pathological stage was associated with a significantly higher risk of breast cancer-related death. Chemotherapy was associated with better BCSS regardless of the pathological stage, but radiotherapy was only associated with better BCSS in stage IIIA disease. Conclusions The 8th AJCC pathological staging system provides more refined stratification for T1-2N1 breast cancer patients after mastectomy and may meet the needs of the current trend of individualized decision making for chemotherapy and radiotherapy in this patient subset.

Canine anal sac gland carcinoma with regional lymph node metastases treated with sacculectomy and lymphadenectomy: Outcome and possible prognostic factors

“…Our study proposes that a N stage based on the number of mLNs may be more appropriate. This aligns with our clinical observations and multiple studies in human carcinomas 17–30 . For example, in breast carcinoma, the N stage is based on number of mLNs, with N1 (1–3 positive nodes), N2 (4–9 positive nodes) and N3 (more than 9 positive nodes) stages being associated with prognosis 53 .…”

“…The number of mLN has been reported as a negative prognostic factor in canine mammary carcinoma 16 and is a well‐established risk factor, included in the TNM stage, for many human carcinomas of diverse histotypes 17–30 . Similarly, we have observed that dogs with ASGC and multiple mLNs appeared to have a worse prognosis than those with one single mLN.…”

Triple-negative breast cancer outcomes: Does AJCC 8th staging improve chemotherapy decision-making

“…As mentioned above, many studies have fully explored the prognostic value of the new AJCC prognostic staging, but its guiding role in treatment decision-making is still not clear. Our previous studies had shown that the new AJCC staging might provide additional treatment decisions, including surgery and radiotherapy [17,30,31]. Regarding the treatment decision for chemotherapy, we also found that patients with T1-2N1M0 disease could obtain survival benefit from chemotherapy irrespective of the pathological prognostic stages [30].…”

“…Our previous studies had shown that the new AJCC staging might provide additional treatment decisions, including surgery and radiotherapy [17,30,31]. Regarding the treatment decision for chemotherapy, we also found that patients with T1-2N1M0 disease could obtain survival benefit from chemotherapy irrespective of the pathological prognostic stages [30]. Moreover, our previous study also observed a survival gain from chemotherapy in T3N0M0 BC patients with 8th AJCC stage IIIA disease but was not in those with stage IA, IB, and IIA diseases [31].…”

Nanomedicine-Based Delivery Strategies for Breast Cancer Treatment and Management

“…The American Joint Committee on Cancer (AJCC) is in control of the tumor-node-metastasis (TNM) method for breast cancer staging that regulates how cancer is categorized and conveyed [ 8 ]. T, N, and M were used to determine the stage number, the size of the cancer tumor, and whether it has spread to surrounding tissue (T), lymph nodes (N), or progressed beyond the breast to other regions of the body (M).…”