Zhang Jingting, Zhao Bochao, Jin Feng
Department of Breast Surgery, First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China.
Breast J. 2019 Sep;25(5):838-847. doi: 10.1111/tbj.13347. Epub 2019 Jun 13.
The prognostic value of the prognostic staging system that incorporated estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (Her-2), and histological grade has been validated in breast cancer (BC) patients, but the staging system seems to be somewhat complex. Recently, an updated bioscore system based on these tumor biological factors was proposed. The purpose of this study was to compare the prognostic stratification between prognostic staging system of American Joint Commission on Cancer (AJCC) and a simplified staging system based on the bioscore system and anatomic TNM staging for BC patients. A total of 44 593 patients with invasive ductal carcinoma who underwent radical resection between 2010 and 2011 were reviewed using the SEER database. The patients were reclassified into different groups according to the anatomic staging system, prognostic staging system, risk bioscore system, and simplified staging system, respectively. The prognostic differences between different groups were compared and clinicopathologic features were analyzed. The anatomic TNM staging failed to clearly distinguish the prognostic difference between stage IIIB and stage IIIC. Therefore, we proposed an adjusted anatomic staging, in which T1N3 and T2N3 were downstaged from stage IIIC to stage IIIB, and T4N2 was upstaged from stage IIIB to stage IIIC. Histological grade III, ER(-), PR(-), and Her-2(-) were identified as independent prognostic factors in the multivariate analysis, and these factors were separately marked as 1 point. There were significant survival differences among different risk points except for the comparison between 0 and 1 point. The higher the risk points, the poorer the prognosis of BC patients. In addition, the curve distance between stage IIA and stage IIB was not significantly broaden according to the prognostic staging system. However, the prognostic stratification for BC patients could be significantly improved by the simplified staging system incorporated the bioscore system and adjusted anatomic staging. Several drawbacks may still exist in the prognostic staging system of AJCC. A simplified staging system that incorporated risk score system and the anatomic staging could provide more accurate prognostic information for BC patients.
包含雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子2（Her-2）和组织学分级的预后分期系统在乳腺癌（BC）患者中的预后价值已得到验证，但该分期系统似乎有些复杂。最近，基于这些肿瘤生物学因素提出了一种更新的生物评分系统。本研究的目的是比较美国癌症联合委员会（AJCC）预后分期系统与基于生物评分系统和解剖学TNM分期的简化分期系统对BC患者的预后分层。利用监测、流行病学和最终结果（SEER）数据库回顾了2010年至2011年间共44593例行根治性切除术的浸润性导管癌患者。根据解剖学分期系统、预后分期系统、风险生物评分系统和简化分期系统，将患者分别重新分类为不同组。比较不同组之间的预后差异并分析临床病理特征。解剖学TNM分期未能明确区分IIIB期和IIIC期之间的预后差异。因此，我们提出了一种调整后的解剖学分期，其中T1N3和T2N3从IIIC期降为IIIB期，T4N2从IIIB期升为IIIC期。组织学III级、ER（-）、PR（-）和Her-2（-）在多变量分析中被确定为独立预后因素，这些因素分别记为1分。除0分和1分比较外，不同风险评分之间存在显著的生存差异。风险评分越高，BC患者的预后越差。此外，根据预后分期系统，IIA期和IIB期之间的曲线距离没有显著加宽。然而，结合生物评分系统和调整后的解剖学分期的简化分期系统可显著改善BC患者的预后分层。AJCC的预后分期系统可能仍存在一些缺点。结合风险评分系统和解剖学分期的简化分期系统可为BC患者提供更准确的预后信息。
