Wang Jun, Lian Chen-Lu, Zhou Ping, Lei Jian, Hua Li, He Zhen-Yu, Wu San-Gang
Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Obstetrics and Gynecology, the First Affiliated Hospital of Xiamen University, Xiamen, China.
Gland Surg. 2021 Jan;10(1):233-241. doi: 10.21037/gs-20-587.
This study respectively analyzed the prognostic value and the role in treatment decision-making [breast-conserving surgery (BCS) + radiotherapy (RT) or mastectomy (MAST)] of the 8th American Joint Committee on Cancer (AJCC) pathological prognostic staging system compared with the 7th AJCC anatomical staging system among early breast cancer patients aged <50 years.
Patients with T1-2N0M0 breast cancer aged <50 years were extracted from the Surveillance, Epidemiology, and End Results database between 2010 and 2014. Breast cancer-specific survival (BCSS) was used as the primary endpoint. Chi-squared test, receiver operating characteristics analysis, Kaplan-Meier method, and multivariate Cox proportional models were used to conduct statistical analysis.
A total of 22,640 female patients were identified, and 24.4% of them reallocated to new stage groups from the 7th to the 8th AJCC staging. Among them, 46.2% (n=10,450) and 53.8% (n=12,190) of patients received BCS + RT and MAST, respectively. The 8th AJCC staging system was an independent prognostic factor for BCSS. Patients treated with BCS + RT had better BCSS compared to those treated with MAST (P<0.001). According to the 8th AJCC staging, BCS + RT could improve 5-year BCSS compared with MAST in patients with stage IA (P=0.006) and stage IB (P=0.001) diseases, while comparable BCSS was found between the two treatment arms in patients' stage IIA disease (P=0.366). Multivariate analyses replicated similar findings after stratification by the 8th AJCC stages.
In patients with T1-2N0 breast cancer and aged <50 years, the 8th AJCC pathological staging system provides accurate prognostic information than the 7th anatomical staging. BCS + RT is the optimal local management for stage IA and IB diseases, while it is the optional management in stage IIA disease according to the 8th AJCC staging.
本研究分别分析了美国癌症联合委员会（AJCC）第8版病理预后分期系统相较于第7版AJCC解剖学分期系统，在年龄＜50岁的早期乳腺癌患者中的预后价值及对治疗决策[保乳手术（BCS）+放疗（RT）或乳房切除术（MAST）]的作用。
从2010年至2014年的监测、流行病学和最终结果数据库中提取年龄＜50岁的T1-2N0M0乳腺癌患者。以乳腺癌特异性生存（BCSS）作为主要终点。采用卡方检验、受试者工作特征分析、Kaplan-Meier法和多变量Cox比例模型进行统计分析。
共确定了22640例女性患者，其中24.4%的患者从第7版AJCC分期重新分配到新的分期组。其中，分别有46.2%（n=10450）和53.8%（n=12190）的患者接受了BCS+RT和MAST。第8版AJCC分期系统是BCSS的独立预后因素。与接受MAST的患者相比，接受BCS+RT治疗的患者BCSS更好（P<0.001）。根据第8版AJCC分期，在IA期（P=0.006）和IB期（P=0.001）疾病患者中，BCS+RT与MAST相比可提高5年BCSS，而在IIA期疾病患者中，两种治疗方式的BCSS相当（P=0.366）。多变量分析在按第8版AJCC分期分层后得出了类似的结果。
在年龄＜50岁的T1-2N0乳腺癌患者中，第8版AJCC病理分期系统比第7版解剖学分期提供了更准确的预后信息。根据第8版AJCC分期，BCS+RT是IA期和IB期疾病的最佳局部治疗方法，而在IIA期疾病中是可选择的治疗方法。
