Wu San-Gang, Wang Jun, Lei Jian, Lian Chen-Lu, Hua Li, Zhou Juan, He Zhen-Yu
Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China.
Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, Teaching Hospital of Fujian Medical University, Xiamen, People's Republic of China.
Clin Transl Med. 2020 Jan;10(1):125-136. doi: 10.1002/ctm2.3. Epub 2020 Apr 23.
T3N0 breast cancer might be a distinct clinical and biological entity, with higher heterogeneity and presenting diverse responses to locoregional and systemic therapy. The aim of the current study was to validate the prognostic effect and assess the treatment decision-making of the American Joint Committee on Cancer (AJCC) eighth pathological prognostic staging in T3N0 breast cancer after mastectomy.
We retrospectively included 2465 patients with stage T3N0 breast cancer who had undergone mastectomy between 2010 and 2014 using the data from Surveillance, Epidemiology, and End Results program. The primary endpoint of this study was breast cancer-specific survival (BCSS).
Of the entire cohort, 76.0% of patients in the seventh AJCC staging system were restaged to the eighth AJCC pathological prognostic staging system. A total of 1431 (58.1%) and 1175 (47.7%) of them received chemotherapy and postmastectomy radiotherapy (PMRT), respectively. Pathological staging was an independent prognostic factor for BCSS. Using pathological prognostic stage IA as the reference, BCSS gradually became worse with increased hazard ratios. The 5-years BCSS was 96.9%, 95.5%, 91.1%, 85.6%, and 75.5% in pathological prognostic stage IA, IB, IIA, IIB, and IIIA breast cancers, respectively (P < .001). In pathological prognostic stage IA, IB, and IIA breast cancers, the receipt of PMRT or chemotherapy was not correlated with better BCSS. However, PMRT was correlated with better BCSS in pathological prognostic stage IIB disease (P = .006), but not in pathological prognostic IIIA disease. Moreover, chemotherapy was correlated with better BCSS in pathological prognostic stage IIIA disease (P = .006), but not in pathological prognostic stage IIB disease.
The eighth AJCC pathological prognostic staging system provides more risk stratification of T3N0 breast cancers after mastectomy and might affect individualized decision-making for chemotherapy and PMRT in this patient subset.
T3N0期乳腺癌可能是一种独特的临床和生物学实体，具有更高的异质性，并且对局部和全身治疗呈现出不同的反应。本研究的目的是验证美国癌症联合委员会（AJCC）第八版病理预后分期在T3N0期乳腺癌乳房切除术后的预后效果，并评估其对治疗决策的影响。
我们利用监测、流行病学和最终结果计划的数据，回顾性纳入了2010年至2014年间接受乳房切除术的2465例T3N0期乳腺癌患者。本研究的主要终点是乳腺癌特异性生存（BCSS）。
在整个队列中，76.0%的患者在第七版AJCC分期系统中的分期被重新划分为第八版AJCC病理预后分期系统。其中分别有1431例（58.1%）和1175例（47.7%）接受了化疗和乳房切除术后放疗（PMRT）。病理分期是BCSS的独立预后因素。以病理预后IA期作为参照，随着风险比增加，BCSS逐渐变差。病理预后IA期、IB期、IIA期、IIB期和IIIA期乳腺癌的5年BCSS分别为96.9%、95.5%、91.1%、85.6%和75.5%（P <.001）。在病理预后IA期、IB期和IIA期乳腺癌中，接受PMRT或化疗与更好的BCSS无关。然而，PMRT与病理预后IIB期疾病更好的BCSS相关（P = 0.006），但与病理预后IIIA期疾病无关。此外，化疗与病理预后IIIA期疾病更好的BCSS相关（P = 0.006），但与病理预后IIB期疾病无关。
第八版AJCC病理预后分期系统为乳房切除术后的T3N0期乳腺癌提供了更多的风险分层，可能会影响该患者亚组化疗和PMRT的个体化决策。
