The assessment of 8th edition AJCC prognostic staging system and a simplified staging system for breast cancer: The analytic results from the SEER database

Abstract

The prognostic value of the prognostic staging system that incorporated estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor‐2 (Her‐2), and histological grade has been validated in breast cancer (BC) patients, but the staging system seems to be somewhat complex. Recently, an updated bioscore system based on these tumor biological factors was proposed. The purpose of this study was to compare the prognostic stratification between prognostic staging system of American Joint Commission on Cancer (AJCC) and a simplified staging system based on the bioscore system and anatomic TNM staging for BC patients. A total of 44 593 patients with invasive ductal carcinoma who underwent radical resection between 2010 and 2011 were reviewed using the SEER database. The patients were reclassified into different groups according to the anatomic staging system, prognostic staging system, risk bioscore system, and simplified staging system, respectively. The prognostic differences between different groups were compared and clinicopathologic features were analyzed. The anatomic TNM staging failed to clearly distinguish the prognostic difference between stage IIIB and stage IIIC. Therefore, we proposed an adjusted anatomic staging, in which T1N3 and T2N3 were downstaged from stage IIIC to stage IIIB, and T4N2 was upstaged from stage IIIB to stage IIIC. Histological grade III, ER(−), PR(−), and Her‐2(−) were identified as independent prognostic factors in the multivariate analysis, and these factors were separately marked as 1 point. There were significant survival differences among different risk points except for the comparison between 0 and 1 point. The higher the risk points, the poorer the prognosis of BC patients. In addition, the curve distance between stage IIA and stage IIB was not significantly broaden according to the prognostic staging system. However, the prognostic stratification for BC patients could be significantly improved by the simplified staging system incorporated the bioscore system and adjusted anatomic staging. Several drawbacks may still exist in the prognostic staging system of AJCC. A simplified staging system that incorporated risk score system and the anatomic staging could provide more accurate prognostic information for BC patients.

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 ].…”

“…In patients with triple-negative tumors (HR(−)/HER2(−)), the five-year mortality was higher than that in patients with HER2-positive tumors (HR(−)/HER2(+)) and so forth, i.e., the five-year mortality was much higher in patients with triple-negative tumors (HR(−)/HER2(−)) > patients HER2-positive tumors (HR(−)/HER2(+)) > patients with luminal B subtype tumors (HR(+)/HER2(−)) > patients with luminal B subtype tumors (HR(+)/HER2(+)) > patients with luminal A subtype tumors (HR(+)/HER2(−)) [ 22 , 23 , 24 , 25 , 26 , 69 , 70 , 71 , 72 , 101 , 102 , 103 , 104 , 105 , 106 ].…”

“…However, the growth rate of the secondary distant MTS may be higher than the natural growth rate of the BC PT [ 2 , 3 , 4 , 6 , 7 ]. For the first time, the growth rates of secondary distant MTSs were divided into five groups depending on the ER/PR/HER2/Ki-67 subtypes and growth rates [ 49 , 50 , 52 , 53 , 54 ]: group I with subtype I of BC (luminal A = HR(+)/HER2(−)) for sdMTSs with very slow growth rates (TVDT MTS = 231–270 days), group II with subtype II of BC (luminal B = HR(+)/HER2(+)) for sdMTSs with slow growth rates (TVDT MTS = 196–230 days), group III with subtype III of BC (luminal B = HR(+)/HER2(−)) for sdMTSs with intermediate growth rates (TVDT MTS = 166–195 days), group IV with subtype IV of BC (HR(−)/HER2(+)—HER2-positive tumors) for sdMTSs with intermediate growth rates (TVDT MTS = 136–165 days), and group V with subtype V (HR(−)/HER2(−)—triple-negative tumors) of BC for sdMTSs with rapid growth rates (TVDT MTS = 10–135 days) [ 2 , 3 , 4 , 6 , 7 , 20 , 22 , 23 , 24 , 25 , 26 , 40 , 47 , 49 , 52 , 53 , 54 , 69 , 70 , 71 , 72 ].…”