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

Lian, Chen-Lu; Li, Guanqiao; Zhou, Ping; Wang, Jun; He, Zhen-Yu; Wu, San‐Gang

doi:10.1016/j.breast.2021.06.009

Cited by 4 publications

(4 citation statements)

References 34 publications

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“…It is worth noting that due to the invalidation of endocrine and target therapies, triple-negative breast cancer tends to be more aggressive and lethal than non-triple-negative breast cancer subtypes (luminal tumors). 28,29 The rate of HER2-neu+ (score 3+) was also increased in both hospitals post-Pathum Raksa. This was more pronounced for KKU with over 65% increase in HER2-neu+ (score 3+).…”

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Pathum Raksa Project: Addressing Disparity in Breast Cancer Care Through National Innovation in Thailand

Koonmee¹,

Somintara²,

Intarawichian³

et al. 2021

CMAR

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Pathum Raksa Project: Addressing Disparity in Breast Cancer Care Through National Innovation in Thailand

Koonmee¹,

Somintara²,

Intarawichian³

et al. 2021

CMAR

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“…In our previous studies, we found that the new AJCC staging can accurately guide individualized treatment of patients with BC in clinical decision-making. Patients who were downstaged from the eighth AJCC PPS can safely avoid adjuvant chemotherapy or radiotherapy [24][25][26]. Therefore, the 8th AJCC staging better reflects the trend of personalized treatment.…”

Section: Discussionmentioning

confidence: 99%

Stage-Specific Survival in Breast Cancer in Chinese and White Women: Comparative Data Analysis

Wang¹,

Zhou²,

Liu³

et al. 2022

JMIR Public Health Surveill

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Background Stage-specific survival, according to the eighth edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging (PPS) on breast cancer (BC), between Chinese and White American women remains unclear. Objective This study aimed to assess stage-specific survival in BC between Chinese and White American women according to the eighth AJCC PPS. Methods We included Chinese and White American women with BC diagnosed between 2010 and 2018 from the Surveillance, Epidemiology, and End Results database. A chi-square test, the Kaplan–Meier method, a receiver operating characteristic (ROC) curve, and multivariate Cox proportional hazards models were used for data analysis. Results We included 376,818 individuals in this study: 369,522 White American and 7296 Chinese. Of them, 149,452 (39.7%) migrated from the seventh AJCC anatomic staging (AS) to the eighth AJCC PPS, 22,516 (6.0%) were upstaged, and 126,936 (33.7%) were downstaged. With a median follow-up duration of 44 months, the 5-year overall survival and cancer-specific survival (CSS) for the entire group were 87.4% and 95.9%, respectively. The seventh AJCC AS (P<.001) and the eighth AJCC PPS (P<.001) could significantly predict the survival outcomes of BC, and multivariate analysis revealed that both staging systems were significant prognostic indicators of CSS. The ROC curve revealed that the PPS had a better discriminating ability than the AS (area under the curve [AUC] 0.769 vs 0.753, P<.001). Similar trends were observed after stratification by the 2 ethnic groups. The eighth AJCC PPS had better discriminating ability than the seventh AJCC AS among both White American (AUC 0.769 vs 0.753, P<.001) and Chinese patients (AUC 0.790 vs 0.776, P<.001). In the seventh AJCC AS, Chinese women had better CSS in stage IA (P=.02), stage IIA (P=.005), and stage IIIB (P=.04) disease than White American women, but no significant CSS was observed in stage IB, IIB, IIIA, and IIIC disease between the 2 ethnic groups. Regarding the eighth AJCC PPS, Chinese women had better CSS in stage IA (P=.002) and IIIA (P=.046) disease than White American women, and CSS was similar in Chinese and White American women in other substages. Conclusions The eighth AJCC PPS has a similar discriminative ability between White American and Chinese individuals with BC compared with the seventh AJCC AS. Therefore, the eighth AJCC PPS is also applicable to Chinese individuals with BC.

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“…Previous studies have found that the new PPS may have an important role in treatment decision-making for stage I to III BC 10 , 11 . However, a recent study showed that PPS did not provide better discriminatory ability of risk stratification compared with the AS in T1-2N0M0 triple-negative BC, but PPS could more accurately predict the efficacy of chemotherapy 12 . In those with hormone receptor-positive (HoR + ) and HER2-positive (HER2 + ) disease, whether PPS exhibits a superior risk stratification than AS is still debatable 13 , 14 .…”

Section: Introductionmentioning

confidence: 95%

Impact of AJCC prognostic staging on prognosis and postmastectomy radiotherapy decision-making in hormone receptor-positive and HER2-positive breast cancer

Zhang

et al. 2022

BJS Open

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Background The role of postmastectomy radiotherapy (PMRT) in patients with node-positive hormone receptor-positive (HoR) and HER2-positive breast cancer (BC) regarding AJCC pathological prognostic staging (PPS) has not been fully determined. This study aimed to validate PPS in patients with node-positive HoR+/HER2+ BC after mastectomy and to investigate the role of PPS on PMRT decision-making in this patient subset. Methods Patients diagnosed with BC from the Surveillance, Epidemiology, and End Results database were included. Patients were classified based on the anatomical staging (AS) and PPS. Breast cancer-specific survival (BCSS) was calculated. Results In total, 6862 patients were included: 4306 (62.8 per cent) patients received PMRT and 2556 (37.2 per cent) patients had not. Compared to AS, PPS downstaged 5260 patients (76.7 per cent) and no patients were upstaged. The C-index was similar between PPS and AS (0.690 versus 0.682; P = 0.346). Regarding AS, patients who received PMRT had significantly better BCSS than those who had not in stage IIIA (P = 0.017) and stage IIIC (P < 0.001) disease, but not in stage IB (P = 0.675), IIA (P = 0.677), IIB (P = 0.100), and IIIB (P = 0.747) disease. Regarding PPS, patients who received PMRT had significantly better BCSS than those who had not in stage IIIA (P = 0.038) and stage IIIB (P = 0.017) disease, but not in stage IA (P = 0.336), IB (P = 0.893), IIA (P = 0.815), and IIB (P = 0.120) disease. PPS might allow approximately 1390 stage III patients (45.0 per cent) in the AS criterion to avoid PMRT. Conclusion PPS does not provide better risk discriminatory ability in predicting prognosis than AS in patients with node-positive HoR+/HER2+ BC after mastectomy. However, PPS is valuable in providing prognostic counselling to patients and may also guide PMRT decision-making.

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

Cited by 4 publications

References 34 publications

Pathum Raksa Project: Addressing Disparity in Breast Cancer Care Through National Innovation in Thailand

Pathum Raksa Project: Addressing Disparity in Breast Cancer Care Through National Innovation in Thailand

Stage-Specific Survival in Breast Cancer in Chinese and White Women: Comparative Data Analysis

Impact of AJCC prognostic staging on prognosis and postmastectomy radiotherapy decision-making in hormone receptor-positive and HER2-positive breast cancer

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