Ali Basim, Mubarik Fatima, Zahid Nida, Sattar Abida K
Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan; and Baylor College of Medicine, Waco, TX.
Medical College, Aga Khan University, Karachi, Pakistan.
JCO Glob Oncol. 2020 Aug;6:1346-1351. doi: 10.1200/GO.20.00257.
National Comprehensive Cancer Network and European Society for Medical Oncology guidelines suggest screening for distant metastasis (M1) in symptomatic patients or those with locally advanced breast cancer. These guidelines are based on studies that often used pathologic staging for analysis. Physician variability in screening for M1 has also resulted in overuse of diagnostic tests. We sought to identify clinicopathologic features at diagnosis that could guide testing for metastatic disease.
Patients diagnosed with invasive breast cancer between January 2014 and December 2015 were identified from our institutional database. Demographic and clinical variables were collected, including receptor profiles and clinical TNM staging. Rates of upstaging for each clinical stage and rates of concordance of pathologic and clinical staging were analyzed. Univariate analysis and multivariate regression analysis ( < .05) identified predictors of upstaging to stage IV disease.
A total of 370 patients met the inclusion criteria. Seventy patients (18.9%) had metastatic disease at diagnosis. The rate of upstaging for stages I, IIA, IIB, and III were 0%, 5.6%, 18.8%, and 36.6%, respectively. Advancing clinical stage, tumor size, and nodal status resulted in a significantly higher rate ( < .001) of upstaging to M1 disease. Age and hormone receptor status were not associated with upstaging to stage IV disease. Clinical stages I-III were concordant with pathologic staging in 65(42.8%) of 152 patients (kappa's index, 0.197; < .000).
Advancing clinical stage, tumor size, and nodal status at diagnosis were predictive of upstaging to M1 disease in patients with breast cancer. Distant metastatic workup should be considered in patients with clinical stage IIB disease or higher.
美国国立综合癌症网络和欧洲医学肿瘤学会指南建议，对有症状的患者或局部晚期乳腺癌患者进行远处转移（M1）筛查。这些指南基于常采用病理分期进行分析的研究。医生在筛查M1时的差异也导致了诊断检查的过度使用。我们试图确定诊断时可指导转移性疾病检测的临床病理特征。
从我们的机构数据库中识别出2014年1月至2015年12月期间诊断为浸润性乳腺癌的患者。收集人口统计学和临床变量，包括受体特征和临床TNM分期。分析每个临床分期的分期上调率以及病理分期与临床分期的一致性率。单因素分析和多因素回归分析（<.05）确定了上调至IV期疾病的预测因素。
共有370例患者符合纳入标准。70例患者（18.9%）在诊断时患有转移性疾病。I期、IIA期、IIB期和III期的分期上调率分别为0%、5.6%、18.8%和36.6%。临床分期进展、肿瘤大小和淋巴结状态导致上调至M1疾病的发生率显著更高（<.001）。年龄和激素受体状态与上调至IV期疾病无关。152例患者中的65例（42.8%）临床I - III期与病理分期一致（kappa指数，0.197；<.000）。
诊断时临床分期进展、肿瘤大小和淋巴结状态可预测乳腺癌患者上调至M1疾病。对于临床IIB期及以上的患者，应考虑进行远处转移检查。
