The comparison of the anatomic stage and pathological prognostic stage according to the AJCC 8th edition for the prognos
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ORIGINAL ARTICLE
The comparison of the anatomic stage and pathological prognostic stage according to the AJCC 8th edition for the prognosis in Japanese breast cancer patients: data from a single institution Eriko Tokunaga1 · Hideki Ijichi1 · Wakako Tajiri1 · Takanobu Masuda1 · Katsumi Takizawa2 · Hiroki Ueo1 · Chinami Koga1 · Junko Tanaka1 · Yoshiaki Nakamura1 · Shinji Ohno3 · Kenichi Taguchi2 · Masahiro Okamoto1 Received: 16 March 2020 / Accepted: 25 May 2020 © The Author(s) 2020
Abstract Background The TNM system, which reflects the anatomical extent of disease, was used for stage definition. In the recently published AJCC 8th edition, the new staging system of the clinical and pathological prognostic stage, which incorporates biological factors, is introduced. Patients and methods A total of 2622 patients with primary breast cancer at stage I–III were included in this study. The anatomic stage (aStage) and the pathological prognostic stage (ppStage) for each case were determined according to the definition of the AJCC 8th edition, and the influence of these stages on the prognosis was compared. Results The stage distributions of aStage and ppStage were as follows: aStage, stage IA (54.8%), IB (1.1%), IIA (26.1%), IIB (9.2%), IIIA (5.6%), IIIB (0.1%), and IIIC (3.1%); and ppStage, stage IA (66.6%), IB (13.1%), IIA (11.1%), IIB (3.2%), IIIA (3.3%), IIIB (1.4%), and IIIC (1.2%). Compared with the aStage, the ppStage stayed the same in 1710 patients (65.2%), was downstaged in 778 patients (29.7%), and was upstaged in 134 patients. The pathological tumor size (pT2) and lymph node metastasis (pN1) were associated with downstaging, and histological grade 3 was associated with upstaging. ER positivity, PgR positivity, and HER2-positivity were significantly associated with downstaging, and the TN subtype was associated with upstaging. Both the aStage and ppStage were significantly associated with the prognosis; however, the Kaplan–Meier curves for the relapse-free survival (RFS), distant recurrence-free survival (DRFS), and overall survival were better stratified by the ppStage. Conclusion The ppStage reflects the prognosis of patients with early breast cancer more accurately than the aStage. Keywords Breast cancer · TNM · AJCC · Pathological prognostic stage
Introduction
* Eriko Tokunaga [email protected]; [email protected] 1
Department of Breast Oncology, National Hospital Organization Kyushu Cancer Center, 3‑1‑1 Notame, Minami‑ku, Fukuoka 811‑1395, Japan
2
Departments of Pathology, National Hospital Organization Kyushu Cancer Center, 3‑1‑1 Notame, Minami‑ku, Fukuoka 811‑1395, Japan
3
Breast Cancer Center, Cancer Institute Hospital, 3‑8‑31 Ariake, Koutou‑ku, Tokyo 135‑8550, Japan
An improved understanding of the breast cancer biology has greatly changed the therapeutic strategies for both early and advanced breast cancer. The evaluations of the expression of estrogen receptor (ER) and progesterone receptor (PgR) and human epidermal growth factor 2 (HER2) status are nec
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