TY - JOUR
T1 - Novel Prognostic Staging System for Patients With De Novo Metastatic Breast Cancer
AU - Plichta, Jennifer K.
AU - Thomas, Samantha M.
AU - Hayes, Daniel F.
AU - Chavez-Macgregor, Mariana
AU - Allison, Kimberly
AU - De Los Santos, Jennifer
AU - Fowler, Amy M.
AU - Giuliano, Armando E.
AU - Sharma, Priyanka
AU - Smith, Benjamin D.
AU - Van Eycken, Elizabeth
AU - Edge, Stephen B.
AU - Hortobagyi, Gabriel N.
N1 - Funding Information:
Supported by the National Institutes of Health Office of Women's Research Building Interdisciplinary Research Careers in Women's Health K12HD043446 (J.K.P.) (PI: Amundsen). Supported in part by Duke Cancer Institute through NIH grant P30CA014236 (PI: Kastan) for the Biostatistics Core.
Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2023/5/10
Y1 - 2023/5/10
N2 - PURPOSEGiven the heterogeneity and improvement in outcomes for metastatic breast cancer (MBC), we developed a staging system that refines prognostic estimates for patients with metastatic cancer at the time of initial diagnosis, de novo MBC (dnMBC), on the basis of survival outcomes and disease-related variables.METHODSPatients with dnMBC (2010-2016) were selected from the National Cancer Database (NCDB). Recursive partitioning analysis (RPA) was used to group patients with similar overall survival (OS) on the basis of clinical T category, grade, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2, histology, organ system site of metastases (bone-only, brain-only, visceral), and number of organ systems involved. Three-year OS rates were used to assign a final stage: IVA: >70%, IVB: 50%-70%, IVC: 25 to <50%, and IVD: <25%. Bootstrapping was applied with 1,000 iterations, and final stage assignments were made based on the most commonly occurring assignment. Unadjusted OS was estimated. Validation analyses were conducted using SEER and NCDB.RESULTSAt a median follow-up of 52.9 months, the median OS of the original cohort (N = 42,467) was 35.4 months (95% CI, 34.8 to 35.9). RPA stratified patients into 53 groups with 3-year OS rates ranging from 73.5% to 5.7%; these groups were amalgamated into four stage groups: 3-year OS, A = 73.2%, B = 61.9%, C = 40.1%, and D = 17% (log-rank P <.001). After bootstrapping, the survival outcomes for the four stages remained significantly different (log-rank P <.001). This staging system was then validated using SEER data (N = 20,469) and a separate cohort from the NCDB (N = 7,645) (both log-rank P <.001).CONCLUSIONOur findings regarding the heterogeneity in outcomes for patients with dnMBC could guide future revisions of the current American Joint Committee on Cancer staging guidelines for patients with newly diagnosed stage IV disease. Our findings should be independently confirmed.
AB - PURPOSEGiven the heterogeneity and improvement in outcomes for metastatic breast cancer (MBC), we developed a staging system that refines prognostic estimates for patients with metastatic cancer at the time of initial diagnosis, de novo MBC (dnMBC), on the basis of survival outcomes and disease-related variables.METHODSPatients with dnMBC (2010-2016) were selected from the National Cancer Database (NCDB). Recursive partitioning analysis (RPA) was used to group patients with similar overall survival (OS) on the basis of clinical T category, grade, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2, histology, organ system site of metastases (bone-only, brain-only, visceral), and number of organ systems involved. Three-year OS rates were used to assign a final stage: IVA: >70%, IVB: 50%-70%, IVC: 25 to <50%, and IVD: <25%. Bootstrapping was applied with 1,000 iterations, and final stage assignments were made based on the most commonly occurring assignment. Unadjusted OS was estimated. Validation analyses were conducted using SEER and NCDB.RESULTSAt a median follow-up of 52.9 months, the median OS of the original cohort (N = 42,467) was 35.4 months (95% CI, 34.8 to 35.9). RPA stratified patients into 53 groups with 3-year OS rates ranging from 73.5% to 5.7%; these groups were amalgamated into four stage groups: 3-year OS, A = 73.2%, B = 61.9%, C = 40.1%, and D = 17% (log-rank P <.001). After bootstrapping, the survival outcomes for the four stages remained significantly different (log-rank P <.001). This staging system was then validated using SEER data (N = 20,469) and a separate cohort from the NCDB (N = 7,645) (both log-rank P <.001).CONCLUSIONOur findings regarding the heterogeneity in outcomes for patients with dnMBC could guide future revisions of the current American Joint Committee on Cancer staging guidelines for patients with newly diagnosed stage IV disease. Our findings should be independently confirmed.
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U2 - 10.1200/JCO.22.02222
DO - 10.1200/JCO.22.02222
M3 - Article
C2 - 36944149
AN - SCOPUS:85159554058
SN - 0732-183X
VL - 41
SP - 2546
EP - 2560
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 14
ER -