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The combined pN stage and breast cancer subtypes in breast cancer: a better discriminator of outcome can be used to refine the 8th AJCC staging manual.
- Source :
- Breast Cancer (13406868); May2018, Vol. 25 Issue 3, p315-324, 10p
- Publication Year :
- 2018
-
Abstract
- Background: pN stage and breast cancer subtypes (BCS) are both well-recognized prognostic indicators. Our previous work has highlighted that patients even with the same pN stage exhibited a significant survival difference in different BCS. Given this achievement, we hypothesized that a statistical interaction might exist between pN stage and BCS. The aim of this retrospective cohort study was to compare the prognostic value of the combined pN stage and BCS (pN<subscript>new</subscript> stage) with either pN stage or BCS alone, and to determine if this combined new stage could serve as an alternative discriminator of outcome.Methods: We combined pN stage and BCS to create a new variable named pN<subscript>new</subscript> stage and then divided it into four groups: pN0<subscript>new</subscript>, pN1<subscript>new</subscript>, pN2<subscript>new</subscript>, and pN3<subscript>new</subscript>. Survival analysis was performed with the use of the Kaplan-Meier method and the log-rank test was used for univariate analysis. For multivariate analysis, cox proportional hazard models were applied, allowing for the estimation of disease-free survival (DFS). To assess discriminatory accuracy of the models, we compared the area under the receiver-operating characteristic curve (AUROC), the Akaike information criterion (AIC), and the Bayesian information criterion (BIC) values. Then, we used this pN<subscript>new</subscript> stage to generate a TN<subscript>new</subscript>M staging system according to the 7th AJCC staging system.Results: A statistical interaction between pN stage and BCS was found. In multivariate survival analysis, the pN<subscript>new</subscript> stage has been confirmed as an independent prognostic variable of 5-year DFS. The pN<subscript>new</subscript> stage, with a smaller AIC or BIC value and larger AUROC, was a more powerful predictor of DFS than either pN stage or BCS alone. Results were validated in a separate cohort of patients. The TN<subscript>new</subscript>M stage proposed in our present study was found comparable to the new 8th AJCC edition which includes anatomic T, N, and M plus tumor grade and the status of the biomarkers Her-2, ER, and PR with respect to prognostic value for breast cancer patients.Conclusions: The pN<subscript>new</subscript> stage (combined pN stage and BCS) appears to be a more powerful predictor and discriminator for the outcome of breast cancer, as compared to pN stage or BCS alone, and the TN<subscript>new</subscript>M stage may serve as a simple, easy-to-use alternative to the 8th AJCC edition staging manual. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 13406868
- Volume :
- 25
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- Breast Cancer (13406868)
- Publication Type :
- Academic Journal
- Accession number :
- 129154782
- Full Text :
- https://doi.org/10.1007/s12282-018-0833-0