Ye Jingming, Wang Wenjun, Xu Ling, Duan Xuening, Cheng Yuanjia, Xin Ling, Zhang Hong, Zhang Shuang, Li Ting, Liu Yinhua
Breast Disease Center, Peking University First Hospital, Beijing 100034, China.
Chin J Cancer Res. 2017 Aug;29(4):351-360. doi: 10.21147/j.issn.1000-9604.2017.04.08.
OBJECTIVE: We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for luminal A breast cancer. METHODS: Using both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system, we restaged patients with luminal A breast cancer treated at the Breast Disease Center, Peking University First Hospital from 2008 to 2014. Follow-up data including 5-year disease free survival (DFS), overall survival (OS) and other clinic-pathological data were collected to analyze the differences between the two staging subgroups. RESULTS: This study included 421 patients with luminal A breast cancer (median follow-up, 61 months). The 5-year DFS and OS rates were 98.3% and 99.3%, respectively. Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages. Significant differences were observed in both 5-year DFS and OS between different prognostic stages. Application of the prognostic staging system resulted in assignment of 175 of 421 patients (41.6%) to a different group compared to their original anatomic stages. In total, 102 of 103 patients with anatomic stage IIA changed to prognostic stage IB, and 24 of 52 patients with anatomic stage IIB changed to prognostic stage IB, while 1 changed to prognostic stage IIIB. Twenty-two of 33 patients with anatomic stage IIIA were down-staged to IIA when staged by prognostic staging system, and the other 11 patients were down-staged to IIB. Two patients with anatomic stage IIIB were down-staged to IIIA. Among seven patients with anatomic stage IIIC cancer, two were down-staged to IIIA and four were down-staged to stage IIIB. CONCLUSIONS: The 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system. More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.
目的:我们回顾性分析了美国癌症联合委员会(AJCC)第8版分期系统对腔面A型乳腺癌的临床预后价值。 方法:利用AJCC癌症分期系统第8版中的解剖学分期和预后分期,我们对2008年至2014年在北京大学第一医院乳腺疾病中心接受治疗的腔面A型乳腺癌患者进行了重新分期。收集包括5年无病生存率(DFS)、总生存率(OS)及其他临床病理数据的随访资料,以分析两个分期亚组之间的差异。 结果:本研究纳入421例腔面A型乳腺癌患者(中位随访时间61个月)。5年DFS率和OS率分别为98.3%和99.3%。不同解剖学疾病分期之间观察到5年DFS存在显著差异,但OS无显著差异。不同预后分期之间在5年DFS和OS方面均观察到显著差异。与原解剖学分期相比,预后分期系统的应用使421例患者中的175例(41.6%)被分到不同组。总共,103例解剖学分期为IIA期的患者中有102例变为预后分期IB期,52例解剖学分期为IIB期的患者中有24例变为预后分期IB期,而1例变为预后分期IIIB期。33例解剖学分期为IIIA期的患者中,当采用预后分期系统进行分期时,22例被降为IIA期,另外11例被降为IIB期。2例解剖学分期为IIIB期的患者被降为IIIA期。在7例解剖学分期为IIIC期癌症的患者中,2例被降为IIIA期,4例被降为IIIB期。 结论:AJCC第8版预后分期系统是乳腺癌分期系统的一项重要补充。需要更多临床试验来证明其指导选择合适的全身治疗及预测乳腺癌预后的能力。
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