TY - JOUR
T1 - Comparative Analysis of Proposed Strategies for Incorporating Biologic Factors into Breast Cancer Staging
AU - Kantor, Olga
AU - Niu, Jiangong
AU - Zhao, Hui
AU - Giordano, Sharon H.
AU - Hunt, Kelly K.
AU - King, Tari A.
AU - Mittendorf, Elizabeth A.
AU - Chavez-MacGregor, Mariana
N1 - Publisher Copyright:
© 2020, Society of Surgical Oncology.
PY - 2020/7/1
Y1 - 2020/7/1
N2 - Background: Tumor biology is an important prognostic factor in breast cancer. This study aimed to compare three staging systems incorporating both biologic factors and anatomic staging (AJCC 8th-edition pathologic prognostic staging, Bioscore, and Risk Score) in a large population-based cohort. Methods: The Surveillance, Epidemiology and End Results program was used to select patients with primary stages 1–4 breast cancer diagnosed in 2010. Patients with inflammatory carcinoma, those with missing data for biologic factors, and those with stages 1–3 disease not treated with surgery were excluded from the study. Estimates of 5-year disease-specific survival (DSS) were calculated using the Kaplan–Meier method. The Harrel concordance index (C-index) and the Akaike Information Criterion were used to compare each model in terms of predicting DSS. Results: The study included 21,901 patients with a median age of 60 years. The median follow-up period was 52 months. All the staging models stratified DSS, with a stepwise decrease in DSS for each increase in risk category or score. The C-index of each model incorporating biologic factors was higher than the C-index for anatomic staging alone (C-index: 0.832 vs. 0.856 for AJCC pathologic prognostic staging, 0.856 for Bioscore, and 0.864 for Risk Score, all p < 0.001). The staging systems incorporating biologic factors did not differ significantly in terms of model fit. Conclusion: Staging systems incorporating biologic factors perform better than anatomic staging alone. Implementation of the AJCC 8th-edition pathologic prognostic staging was an important initial step in the inclusion of tumor biology in staging. Given its simplicity and ease of use, the Risk Score should be given consideration as an alternative staging system.
AB - Background: Tumor biology is an important prognostic factor in breast cancer. This study aimed to compare three staging systems incorporating both biologic factors and anatomic staging (AJCC 8th-edition pathologic prognostic staging, Bioscore, and Risk Score) in a large population-based cohort. Methods: The Surveillance, Epidemiology and End Results program was used to select patients with primary stages 1–4 breast cancer diagnosed in 2010. Patients with inflammatory carcinoma, those with missing data for biologic factors, and those with stages 1–3 disease not treated with surgery were excluded from the study. Estimates of 5-year disease-specific survival (DSS) were calculated using the Kaplan–Meier method. The Harrel concordance index (C-index) and the Akaike Information Criterion were used to compare each model in terms of predicting DSS. Results: The study included 21,901 patients with a median age of 60 years. The median follow-up period was 52 months. All the staging models stratified DSS, with a stepwise decrease in DSS for each increase in risk category or score. The C-index of each model incorporating biologic factors was higher than the C-index for anatomic staging alone (C-index: 0.832 vs. 0.856 for AJCC pathologic prognostic staging, 0.856 for Bioscore, and 0.864 for Risk Score, all p < 0.001). The staging systems incorporating biologic factors did not differ significantly in terms of model fit. Conclusion: Staging systems incorporating biologic factors perform better than anatomic staging alone. Implementation of the AJCC 8th-edition pathologic prognostic staging was an important initial step in the inclusion of tumor biology in staging. Given its simplicity and ease of use, the Risk Score should be given consideration as an alternative staging system.
UR - http://www.scopus.com/inward/record.url?scp=85077531597&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85077531597&partnerID=8YFLogxK
U2 - 10.1245/s10434-019-08169-y
DO - 10.1245/s10434-019-08169-y
M3 - Article
C2 - 31916091
AN - SCOPUS:85077531597
SN - 1068-9265
VL - 27
SP - 2229
EP - 2237
JO - Annals of surgical oncology
JF - Annals of surgical oncology
IS - 7
ER -