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Comparative Study
. 2018 Feb 1;4(2):203-209.
doi: 10.1001/jamaoncol.2017.4298.

Validation Study of the American Joint Committee on Cancer Eighth Edition Prognostic Stage Compared With the Anatomic Stage in Breast Cancer

Anna Weiss  1 , Mariana Chavez-MacGregor  2   3 , Daphne Y Lichtensztajn  4 , Min Yi  1 , Audree Tadros  1 , Gabriel N Hortobagyi  2 , Sharon H Giordano  2   3 , Kelly K Hunt  1 , Elizabeth A Mittendorf  1
Affiliations
Comparative Study

Validation Study of the American Joint Committee on Cancer Eighth Edition Prognostic Stage Compared With the Anatomic Stage in Breast Cancer

Anna Weiss et al. JAMA Oncol. .

Abstract

Importance: The American Joint Committee on Cancer (AJCC) eighth edition staging manual introduced a new prognostic stage for breast cancer incorporating biologic factors in addition to traditional anatomic factors.

Objective: To perform a validation study of the AJCC eighth edition prognostic stage in a single-institution cohort and a large population database.

Design, setting, and participants: Patients with breast cancer treated with surgery as an initial intervention were identified in a prospective institutional database from The University of Texas MD Anderson Cancer Center and the California Cancer Registry. Vital status data were complete through December 31, 2016, in The University of Texas MD Anderson cohort and through December 31, 2014, in the California Cancer Registry cohort. Patients receiving neoadjuvant systemic therapy, those with inflammatory or rare breast cancers, and those with unknown clinicopathologic factors were excluded. Factors evaluated included T, N, and M categories and tumor grade, as well as estrogen receptor, progesterone receptor, and HER2 status.

Main outcomes and measures: Disease-specific survival was calculated by the Kaplan-Meier method. The Harrell concordance index (C index) was used to quantify models' predictive performance, and the Akaike information criterion (AIC) was used to compare model fits.

Results: A total of 3327 patients with stage I to IIIC breast cancer treated between 2007 and 2013 at The University of Texas MD Anderson Cancer Center (median follow-up of 5 years) with complete clinicopathologic data were identified. Compared with the AJCC anatomic stage, the prognostic stage upstaged 29.5% of patients and downstaged 28.1%. The prognostic stage (C index, 0.8357 and AIC, 816.8) provided more accurate stratification with respect to disease-specific survival than the anatomic stage (C index, 0.737 and AIC, 1039.8) (P < .001 for the C index). A total of 54 727 patients with stage I to IV breast cancer treated between 2005 and 2009 were identified in the California Cancer Registry (median follow-up of 7 years). The prognostic stage upstaged 31.0% of patients and downstaged 20.6%. The prognostic stage (C index, 0.8426 and AIC, 80 661.68) performed better than the anatomic stage (C index, 0.8097 and AIC, 81 577.89) (P < .001 for the C index).

Conclusions and relevance: The prognostic stage provided more accurate prognostic information than the anatomic stage alone in both a single-institution cohort and a large population database, thereby supporting its use in breast cancer staging.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Chavez-MacGregor reported being a consultant for Novartis, Pfizer, and Roche. Dr Hortobagyi reported being the principal investigator for clinical trials supported by Novartis; reported being a consultant for Antigen Express, AstraZeneca, Genentech, Novartis, Peregrine, and Pfizer; and reported being the chairman of the scientific advisory committee for Agendia. Dr Hunt reported being a consultant for Armada Health. Dr Mittendorf reported being the principal investigator for clinical trials supported by AstraZeneca, Galena Biopharma, and Genentech and reported being a consultant for Amgen. No other disclosures were reported.

Figures

Figure.
Figure.. Disease-Specific Survival (DSS)
Kaplan-Meier curves were used to determine DSS for The University of Texas MD Anderson cohort (A and B) and for the California Cancer Registry (C and D). AIC indicates Akaike information criterion.
See this image and copyright information in PMC

Comment in

References

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