Department of Surgery, Mayo Clinic Rochester, Rochester, MN, USA.
Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery - Mayo Clinic Rochester, Rochester, MN, USA.
Ann Surg Oncol. 2017 Nov;24(12):3510-3517. doi: 10.1245/s10434-017-6010-4. Epub 2017 Aug 21.
Improved staging systems that better predict survival for breast cancer patients who receive neoadjuvant chemotherapy (NAC) by accounting for clinical pathological stage plus estrogen receptor (ER) and grade (CPS+EG) and ERBB2 status (Neo-Bioscore) have been proposed. We sought to evaluate the generalizability and performance of these staging systems in a national cohort.
The National Cancer Database (2006-2012) was reviewed for patients with breast cancer who received NAC and survived ≥90 days after surgery. Four systems were evaluated: clinical/pathologic American Joint Committee on Cancer (AJCC) 7th edition, CPS+EG, and Neo-Bioscore. Unadjusted Kaplan-Meier analysis and adjusted Cox proportional hazards models quantified overall survival (OS). Systems were compared using area under the curve (AUC) and integrated discrimination improvement (IDI).
Overall, 43,320 patients (5-year OS 76.0, 95% confidence interval [CI] 75.4-76.5%) were included, 12,002 of whom had evaluable Neo-Bioscore. AUC at 5 years for CPS+EG (0.720, 95% CI 0.714-0.726) and Neo-Bioscore (0.729, 95% CI 0.716-0.742) were improved relative to AJCC clinical (0.650, 95% CI 0.643-0.656) and pathologic (0.683, 95% CI 0.676-0.689) staging. Both CPS+EG (IDI 7.2, 95% CI 6.6-7.7%) and Neo-Bioscore (IDI 9.8, 95% CI 8.0-11.6%) demonstrated superior discrimination when compared with AJCC clinical staging at 5 years. Comparison of CPS+EG with Neo-Bioscore yielded an IDI of 2.6% (95% CI 0.9-4.5%), indicating that Neo-Bioscore is the best staging system.
In a heterogenous national cohort of breast cancer patients treated with NAC and surgery, the incorporation of chemotherapy response, tumor grade, ER status, and ERBB2 status into the staging system substantially improved on the AJCC TNM staging system in discrimination of OS. Neo-Bioscore provided the best staging discrimination.
通过考虑临床病理分期加雌激素受体（ER）和分级（CPS+EG）和 ERBB2 状态（Neo-Bioscore），提出了一些能够更好地预测接受新辅助化疗（NAC）的乳腺癌患者生存情况的改良分期系统。我们试图评估这些分期系统在全国队列中的通用性和性能。
对 2006-2012 年接受 NAC 且术后存活≥90 天的乳腺癌患者的国家癌症数据库进行了回顾。评估了四种系统：临床/病理美国癌症联合委员会（AJCC）第 7 版、CPS+EG 和 Neo-Bioscore。使用未调整的 Kaplan-Meier 分析和调整后的 Cox 比例风险模型量化总生存（OS）。使用曲线下面积（AUC）和综合判别改善（IDI）比较系统。
共有 43320 例患者（5 年 OS 为 76.0%，95%置信区间[CI]为 75.4-76.5%）入组，其中 12002 例患者可评估 Neo-Bioscore。CPS+EG（0.720，95%CI 0.714-0.726）和 Neo-Bioscore（0.729，95%CI 0.716-0.742）的 5 年 AUC 优于 AJCC 临床（0.650，95%CI 0.643-0.656）和病理（0.683，95%CI 0.676-0.689）分期。与 AJCC 临床分期相比，CPS+EG（IDI 7.2，95%CI 6.6-7.7%）和 Neo-Bioscore（IDI 9.8，95%CI 8.0-11.6%）在 5 年内均具有更好的鉴别能力。CPS+EG 与 Neo-Bioscore 的 IDI 为 2.6%（95%CI 0.9-4.5%），表明 Neo-Bioscore 是最佳的分期系统。
在接受 NAC 和手术治疗的异质性全国乳腺癌患者队列中，将化疗反应、肿瘤分级、ER 状态和 ERBB2 状态纳入分期系统可显著提高 AJCC TNM 分期系统对 OS 的区分能力。Neo-Bioscore 提供了最佳的分期鉴别能力。
