The Assessment Of 8th Edition Ajcc Prognostic Staging System And A Simplified Staging System For Breast Cancer

Background and objectives: Recently,the novel prognostic staging for breast cancer(BC)was proposed by the American Joint Commission on Cancer(AJCC),which incorporated the information on biological factors including ER,PR,Her-2 and histological grade with the anatomic TNM staging.In the present study,we investigated whether the prognostic staging system could properly evaluate the prognosis of BC patients.Methods: A total of 44,593 BC patients with invasive ductal carcinoma from the National Cancer Institute's Surveillance,Epidemiology,and End Results(SEER)database between January 2010 and January 2011 were reviewed in this study.All patients in our cohort were reclassified into different groups according to the anatomic TNM staging and prognostic staging.The prognostic differences between different patient groups were compared and clinicopathologic features correlated with the prognosis of BC patients were analyzed.Results: The histological grade,ER,PR,Her-2 and TNM stage were identified as independent prognostic factors in the multivariate analysis.The prognostic difference between stage III and stage IIIC in the anatomic TNM staging was not discriminated properly,and the curve distance between stage IIA and stage IIB in the prognostic staging was not significantly broaden.According to the risk bioscore system,there were the significant survival differences among different risk points except for the comparison between 0 point and 1 point.Therefore,the adjusted anatomic staging was proposed,in which T1N3 and T2N3 group were downstaged from stage IIIC to stage IIIB,and T4N2 group were upstaged from stage IIIB to stage IIIC.The alternative staging system that incorporated the adjusted anatomic staging with the risk bioscore system could provide a better prognostic stratification for the stage IIA-IIB patients.Conclusion: Compared with the anatomic staging,the prognosis of BC patients was further stratified by the prognostic staging.Despite the obvious superiority,several drawbacks may still exist in the staging system.A simple and alternative staging system that incorporated the anatomic staging with risk bioscore system showed the superiority of prognostic stratification for BC patients,but it still need be validated by the larger patient cohorts from different countries and areas.