Ding Shuning, Zong Yu, Lin Caijin, Andriani Lisa, Chen Weilin, Liu Deyue, Chen Weiguo, Li Yafen, Shen Kunwei, Wu Jiayi, Zhu Li
Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA, United States.
Front Oncol. 2020 Aug 18;10:1471. doi: 10.3389/fonc.2020.01471. eCollection 2020.
The objective of this study was to evaluate the American Joint Committee on Cancer (AJCC) pathological prognostic stage among patients with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) and to propose a modified score system if necessary. Women diagnosed with IDC and ILC during 2010-2015 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively identified. Disease-specific survival (DSS) and overall survival (OS) were estimated by Kaplan-Meier method. Predictive performances of different staging systems were evaluated based on Harrell concordance index (C-index) and Akaike Information Criterion (AIC). Multivariate Cox models were conducted to build preferable score systems. A total of 184,541 female patients were included in the final analyses, with a median follow-up of 30.0 months. In IDC cohort, the pathological prognostic stage (C-index, 0.8281; AIC, 110274.5) was superior to the anatomic stage (C-index, 0.8125; AIC, 112537.0; < 0.001 for C-index) in risk stratification with respect to DSS. In ILC cohort, the prognostic stage (C-index, 0.8281; AIC, 7124.423) didn't outperform the anatomic stage (C-index, 0.8324; AIC, 7144.818; = 0.748 for C-index) with respect to DSS. Similar results were observed with respect to OS. The score system defined by anatomic stage plus grade plus estrogen receptor and progesterone receptor (AS+GEP) allows for better staging (C-index, 0.8085; AIC, 7178.448) for ILC patients. Compared with anatomic stage, the pathological prognostic stage provided more accurate stratification for patients with IDC, but not for patients with ILC. The AS+GEP score system may fit ILC tumors better.
本研究的目的是评估美国癌症联合委员会（AJCC）对浸润性导管癌（IDC）和浸润性小叶癌（ILC）患者的病理预后分期，并在必要时提出一种改良的评分系统。回顾性确定了2010 - 2015年期间在监测、流行病学和最终结果（SEER）数据库中诊断为IDC和ILC的女性患者。采用Kaplan-Meier法估计疾病特异性生存率（DSS）和总生存率（OS）。基于Harrell一致性指数（C指数）和赤池信息准则（AIC）评估不同分期系统的预测性能。进行多变量Cox模型以建立更优的评分系统。最终分析共纳入184,541例女性患者，中位随访时间为30.0个月。在IDC队列中，就DSS的风险分层而言，病理预后分期（C指数，0.8281；AIC，110274.5）优于解剖学分期（C指数，0.8125；AIC，112537.0；C指数比较，P < 0.001）。在ILC队列中，就DSS而言，预后分期（C指数，0.8281；AIC，7124.423）并未优于解剖学分期（C指数，0.8324；AIC，7144.818；C指数比较，P = 0.748）。在OS方面观察到类似结果。由解剖学分期加分级加雌激素受体和孕激素受体定义的评分系统（AS + GEP）对ILC患者具有更好的分期效果（C指数，0.8085；AIC，7178.448）。与解剖学分期相比，病理预后分期为IDC患者提供了更准确的分层，但对ILC患者则不然。AS + GEP评分系统可能更适合ILC肿瘤。
