Young Jessica, Asaoka Mariko, Ghasemi Farhad, Chida Kohei, Roy Arya Mariam, Yan Li, Hakamada Kenichi, Takabe Kazuaki
Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
Ann Surg Oncol. 2025 May;32(5):3268-3277. doi: 10.1245/s10434-025-16889-7. Epub 2025 Feb 7.
The American Joint Committee on Cancer (AJCC) eighth-edition breast cancer staging system incorporating tumor grade, hormone/human epidermal growth factor receptor 2 (HER2) receptor status, and genomic assays has demonstrated better prognostic value than the seventh edition. Given the crucial role of cancer biology in prognosis, the authors hypothesized that the AJCC eighth-edition criteria offer better biologic differentiation between stages than the seventh edition.
This study analyzed 696 breast cancer patients from The Cancer Genome Atlas (TCGA) and Text Information Extraction System (TIES) database, with complete information available for staging according to both the AJCC seventh- and eighth-edition criteria.
The study indicated an increase in the number of patients classified as stage I in the eighth edition compared with the seventh edition, particularly in hormone-positive breast cancers. Furthermore, the eighth edition demonstrated improved discrimination in overall survival between stages I and II cancers. The eighth edition was able to distinguish significant differences in cell proliferation, intratumor heterogeneity, homologous recombination deficiency, and neoantigen load between stages I and II cancers. Moreover, the eighth edition more clearly differentiated immune cell infiltration between stages II and I cancer than the seventh edition. Finally, immune activity and gene expression of immune checkpoints such as PDCD1, PDL1, CTLA4, LAG3, TIGIT, and IDO1 and 2 showed a more pronounced difference between stages I and II cancers in the eighth edition than in the seventh edition.
The AJCC eighth edition breast cancer staging system better distinguishes cancers with more aggressive biology than the seventh edition.
美国癌症联合委员会（AJCC）第八版乳腺癌分期系统纳入了肿瘤分级、激素/人表皮生长因子受体2（HER2）受体状态和基因组检测，已证明其预后价值优于第七版。鉴于癌症生物学在预后中的关键作用，作者推测AJCC第八版标准在各阶段之间提供了比第七版更好的生物学区分。
本研究分析了来自癌症基因组图谱（TCGA）和文本信息提取系统（TIES）数据库的696例乳腺癌患者，这些患者可根据AJCC第七版和第八版标准获得完整的分期信息。
研究表明，与第七版相比，第八版中分类为I期的患者数量有所增加，尤其是在激素阳性乳腺癌中。此外，第八版在I期和II期癌症的总生存区分方面有所改善。第八版能够区分I期和II期癌症在细胞增殖、肿瘤内异质性、同源重组缺陷和新抗原负荷方面的显著差异。此外，与第七版相比，第八版在II期和I期癌症之间更清楚地区分了免疫细胞浸润。最后，免疫活性以及诸如PDCD1、PDL1、CTLA4、LAG3、TIGIT和IDO1及2等免疫检查点的基因表达在第八版中I期和II期癌症之间的差异比第七版中更为明显。
与第七版相比，AJCC第八版乳腺癌分期系统能更好地区分具有更具侵袭性生物学行为的癌症。
