Shi Jian, Lian Chen-Lu, Chi Feng, Zhou Ping, Lei Jian, Hua Li, Wang Jun, He Zhen-Yu, Wu San-Gang
Division of Breast Surgery, the University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China.
Front Oncol. 2020 Dec 18;10:570175. doi: 10.3389/fonc.2020.570175. eCollection 2020.
To investigate the prognostic and predictive effect of the American Joint Committee on Cancer (AJCC) 8 edition pathological prognostic staging system in patients with T1-2N1micM0 breast cancer who underwent mastectomy.
Data from T1-2N1micM0 breast cancer patients who underwent mastectomy from 2010-2014 were obtained from the Surveillance, Epidemiology, and End Results program. The chi-square test, binomial logistics regression, receiver-operating characteristics curve, competing-risk regression model, Cox proportional hazards regression model, and proportional hazard assumption were used for statistical analyses.
We identified 4,729 patients, including 1,062 patients were received postmastectomy radiotherapy (PMRT). Stage change occurred in 88.2% of the patients, of which 84.4% were downstaged and 3.7% were upstaged. Patients with higher pathological prognostic stages were independently predicted to receive PMRT. The 5-year breast cancer-specific survival (BCSS) was 97.5, 93.7, 90.1, 86.0, and 73.5% in disease stages IA, IB, IIA, IIB, and IIIA, respectively, according to the 8 edition criteria (P < 0.001). The AJCC 8 edition demonstrated moderate discriminative ability, and it had a significantly better ability to predict the BCSS than the AJCC 7 edition criteria (P < 0.001). The multivariate prognostic analysis showed that the new pathological prognostic staging was an independent prognostic factor affecting the BCSS. The BCSS worsened with an increase in the stage. The PMRT did not affect the BCSS regardless of the pathological prognostic stage. Similar trends were found using the competing-risks regression model.
The 8 AJCC breast cancer pathological prognostic staging system downstaged 84.4% of patients with T1-2N1micM0 disease and the survival outcome prediction with this staging system was more accurate than the AJCC 7 edition system. Our study does not support using the prognostic stage as a guideline to escalate of PMRT.
探讨美国癌症联合委员会（AJCC）第8版病理预后分期系统对接受乳房切除术的T1-2N1micM0期乳腺癌患者的预后及预测作用。
从监测、流行病学和最终结果计划中获取2010 - 2014年接受乳房切除术的T1-2N1micM0期乳腺癌患者的数据。采用卡方检验、二项逻辑回归、受试者工作特征曲线、竞争风险回归模型、Cox比例风险回归模型和比例风险假设进行统计分析。
我们共纳入4729例患者，其中1062例接受了乳房切除术后放疗（PMRT）。88.2%的患者出现分期改变，其中84.4%分期降低，3.7%分期升高。病理预后分期较高的患者被独立预测会接受PMRT。根据第8版标准，疾病IA、IB、IIA、IIB和IIIA期患者的5年乳腺癌特异性生存率（BCSS）分别为97.5%、93.7%、90.1%、86.0%和73.5%（P < 0.001）。AJCC第8版显示出中等的判别能力，其预测BCSS的能力明显优于AJCC第7版标准（P < 0.001）。多因素预后分析表明，新的病理预后分期是影响BCSS的独立预后因素。BCSS随分期增加而恶化。无论病理预后分期如何，PMRT均不影响BCSS。使用竞争风险回归模型也发现了类似趋势。
AJCC第8版乳腺癌病理预后分期系统使84.4%的T1-2N1micM0期患者分期降低，该分期系统对生存结局的预测比AJCC第7版系统更准确。我们的研究不支持将预后分期作为提高PMRT剂量的指导原则。
