Department of Surgery, St. Vincent's University Hospital, Dublin, Ireland.
School of Medicine, University College Dublin, Dublin, Ireland.
Pathobiology. 2019;86(2-3):77-82. doi: 10.1159/000493363. Epub 2018 Oct 22.
The American Joint Commission Cancer (AJCC) Cancer Staging Manual 8th edition introduced a breast cancer (BC) Prognostic Stage (PS) that combines tumour grade, oestrogen (ER), progesterone (PgR), and human epidermal growth factor-2 (HER2) receptor status with Anatomic TNM Stage (AS). In a further modification, patients with early BC and an Oncotype DX® Recurrence Score (RS) < 11 are assigned to PS 1A irrespective of grade and size up to 5 cm. This study profiles the impact of these changes on staging in patients with early BC and RS < 11.
A total of 127 patients, with primary BC and RS < 11, were identified from a consecutive series of 729 patients with ER-positive, HER2-negative, lymph node-negative, primary BC whose tumours were tested using the Oncotype DX® 21 multigene assay. Each patient was assigned AS, PS, and RS-modified PS, and staging categories were compared.
Applying AS, 100 patients were stage IA and 27 IIA. Applying PS, 89 were stage IA, 33 IB, 4 IIA, and 1 IIB. All patients were IA according to RS-modified PS. Comparing PS to AS, 26.7% of patients (n = 34) changed stage, 9.4% (n = 12) to a higher and 17.3% (n = 22) to a lower stage. RS-modified PS versus AS resulted in downstaging in 21.3% (n = 27). Comparing PS modified by RS to PS alone, 29.9% (n = 38) were downstaged.
Application of PS and RS-modified PS results in tumour downstaging in approximately 20% of patients with early BC. Upstaging was observed in 9% of patients when staged according to PS and was primarily due to the impact of high histological grade.
美国联合委员会癌症（AJCC）第 8 版癌症分期手册引入了一种乳腺癌（BC）预后分期（PS），该分期将肿瘤分级、雌激素（ER）、孕激素（PgR）和人类表皮生长因子-2（HER2）受体状态与解剖学 TNM 分期（AS）相结合。在进一步的修改中，早期 BC 患者和 Oncotype DX®复发评分（RS）<11 的患者，无论分级和大小（最大 5cm）如何，均被分配到 PS 1A。本研究分析了这些变化对早期 BC 和 RS<11 的患者分期的影响。
从连续的 729 例 ER 阳性、HER2 阴性、淋巴结阴性、原发性 BC 患者的连续系列中确定了 127 例原发性 BC 和 RS<11 的患者，其肿瘤使用 Oncotype DX®21 多基因检测进行了检测。每位患者均被分配了 AS、PS 和 RS 修正 PS，并比较了分期类别。
应用 AS，100 例患者为 IA 期，27 例为 IIA 期。应用 PS，89 例为 IA 期，33 例为 IB 期，4 例为 IIA 期，1 例为 IIB 期。根据 RS 修正 PS，所有患者均为 IA 期。与 AS 相比，PS 改变了 26.7%（n=34）的分期，9.4%（n=12）为更高分期，17.3%（n=22）为更低分期。RS 修正 PS 与 AS 相比，21.3%（n=27）降期。与 PS 相比，PS 修正后 RS 使 29.9%（n=38）降期。
在早期 BC 患者中，应用 PS 和 RS 修正 PS 可使肿瘤分期降低约 20%。当按 PS 分期时，观察到 9%的患者分期升高，主要是由于高组织学分级的影响。
