Ding Jinhua, Wu Weizhu, Fang Jianjiang, Chu Yudong, Zheng Siming, Jiang Li
1 Department of Breast and Thyroid Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo - PR China.
2 Department of Emergency Medicine, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo - PR China.
Int J Biol Markers. 2018 May;33(2):168-173. doi: 10.5301/ijbm.5000302. Epub 2017 Sep 25.
This study aimed to investigate staging changes for Chinese breast cancer patients assessed by the 7 (anatomic) and 8 (prognostic) editions of the AJCC staging manual, and to explore the predictive factors for these changes.
Data of patients who received curative surgery for stage I-III breast cancer at Ningbo Medical Center Lihuili Eastern Hospital were retrospectively reviewed. The assessment of staging was according to the criteria of the 7 and 8 editions of the AJCC staging manual. Univariate and multivariate logistic regression analyses were performed to analyze the associations between staging changes and clinicopathological characteristics.
Staging changes were found in 59.37% of patients and were more likely to be seen in stage IIIA (96.10%) and IIA (85.94%), then IIB (70.33%), IB (68.75%), followed by IA (36.17%) and IIIC (30.08%). In univariate analysis, staging changes were associated with tumor location, clinical tumor size, clinical axillary lymph node status and Ki67 index. However, multivariate analysis found that staging changes were significantly associated with tumor size >2 cm (odds ratio [OR] = 3.263, 95% confidence interval [95% CI], 2.638-4.036), lymph node involvement (OR = 2.261, 95% CI, 1.830-2.794) and high Ki-67 index (OR = 1.661, 95% CI 1.343-2.054).
Our study demonstrated that there were marked staging changes when 2 different editions of the AJCC staging manual were used. Since prognostic biomarkers are available in routine clinical practice, the more recent staging manual should be followed to select better systemic therapy and give better outcomes for Chinese breast cancer patients.
本研究旨在调查依据美国癌症联合委员会（AJCC）分期手册第7版（解剖学分期）和第8版（预后分期）评估的中国乳腺癌患者的分期变化，并探索这些变化的预测因素。
回顾性分析在宁波医疗中心李惠利东部医院接受I-III期乳腺癌根治性手术患者的数据。分期评估依据AJCC分期手册第7版和第8版的标准。进行单因素和多因素逻辑回归分析，以分析分期变化与临床病理特征之间的关联。
59.37%的患者出现分期变化，其中IIIA期（96.10%）和IIA期（85.94%）患者的分期变化更为常见，其次是IIB期（70.33%）、IB期（68.75%），随后是IA期（36.17%）和IIIC期（30.08%）。单因素分析显示，分期变化与肿瘤位置、临床肿瘤大小、临床腋窝淋巴结状态和Ki67指数相关。然而，多因素分析发现，分期变化与肿瘤大小>2 cm（比值比[OR]=3.263，95%置信区间[95%CI]，2.638-4.036）、淋巴结受累（OR=2.261，95%CI，1.830-2.794）和高Ki-67指数（OR=1.661，95%CI 1.343-2.054）显著相关。
我们的研究表明，使用2个不同版本的AJCC分期手册时存在明显的分期变化。由于在常规临床实践中可获得预后生物标志物，对于中国乳腺癌患者，应遵循最新的分期手册来选择更好的全身治疗方案并获得更好的治疗效果。
