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. 2020 Jun:51:2-10.
doi: 10.1016/j.breast.2020.02.012. Epub 2020 Mar 3.

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

San-Gang Wu  1 , Jun Wang  1 , Chen-Lu Lian  1 , Jian Lei  2 , Li Hua  2 , Qin Lin  1 , Yong-Xiong Chen  3 , Zhen-Yu He  4
Affiliations

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

San-Gang Wu et al. Breast. 2020 Jun.

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.

Keywords: AJCC; Breast cancer; Chemotherapy; Mastectomy; Radiotherapy.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
The patient selection flowchart of the study.
Fig. 2
Fig. 2
Kaplan-Meier curves of breast cancer-specific survival (A) and cumulative incidence estimates of breast cancer-related death (B) stratified by prognostic stage.
Fig. 3
Fig. 3
Kaplan-Meier curves for assessment of the effect of chemotherapy on breast cancer-specific survival stratified by prognostic stage (A, stage IA; B, stage IB; C, stage IIA; D, stage IIB; E, stage IIIA).
Fig. 4
Fig. 4
Cumulative incidence estimates of the effect of chemotherapy on breast cancer-related death stratified by prognostic stage (A, stage IA; B, stage IB; C, stage IIA; D, stage IIB; E, stage IIIA).
Fig. 5
Fig. 5
Kaplan-Meier curves for assessment of the effect of radiotherapy on breast cancer-specific survival stratified by prognostic stage (A, stage IA; B, stage IB; C, stage IIA; D, stage IIB; E, stage IIIA).
Fig. 6
Fig. 6
Cumulative incidence estimates of the effect of radiotherapy on breast cancer-related death stratified by prognostic stage (A, stage IA; B, stage IB; C, stage IIA; D, stage IIB; E, stage IIIA).
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