美国癌症联合会（AJCC）乳腺癌分期系统第8版已对先行手术患者进行验证，不过尚未检验其对术前新辅助化疗患者预后的影响。
8月2日，美国乳腺外科医师学会和美国肿瘤外科学会《肿瘤外科学报》在线发表芝加哥大学、北岸大学医疗系统的研究报告，分析了第8版分期系统对乳腺癌术前新辅助化疗患者的预后价值。
该研究根据美国国家癌症研究所（NCI）全国癌症数据库（NCDB）对～进行术前新辅助化疗的5万7466例I～III期单侧乳腺浸润癌患者进行回顾分析。通过生存曲线分析，比较临床分期第7版与第8版对推算总生存的预测拟合度。
结果，平均随访41.5个月，第8版与第8版分期相比：
临床分期下调患者比例：37.5%
临床分期上调患者比例：27.8%
临床分期总生存曲线下面积：0.67比0.62（P<0.01）
病理分期总生存曲线下面积：0.70比0.66（P<0.01）
因此，该研究结果表明，第8版临床分期改变的患者比例达65%，第8版预后分期与第7版解剖分期相比，对总生存的预测价值较好。虽然需要采用独立数据集对这些结果进行验证，但是第8版分期将有助于提高乳腺癌术前新辅助化疗患者的预后模型水平。
Ann Surg Oncol. Aug 2. [Epub ahead of print]
The Prognostic Value of the AJCC 8th Edition Staging System for Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer.
Kantor O, Bao J, Jaskowiak N, Yao K, Tseng J.
University of Chicago, Chicago, USA; NorthShore University HealthSystem, Evanston, USA.
BACKGROUND: The American Joint Committee on Cancer (AJCC) 8th edition staging system for breast cancer has been validated in the upfront surgery setting, but has not been examined for its prognostic impact on patients undergoing neoadjuvant chemotherapy.
METHODS: The National Cancer Data Base was used to identify patients with invasive unilateral breast cancer from to who underwent neoadjuvant chemotherapy. AJCC clinical stage classification was compared between the 7th and 8th editions. Receiver operating characteristic analysis of Kaplan-Meier overall survival (OS) was used to determine the predictive fit of the 7th and 8th edition staging in estimating OS.
RESULTS: AJCC 7th and 8th clinical staging assignments were applied to 57,466 patients who underwent neoadjuvant chemotherapy for stage I-III breast cancer from to . Overall, 37.5% of patients were downstaged and 27.8% were upstaged from the 7th to the 8th edition classification. Kaplan-Meier curves comparing 7th and 8th edition staging differed in OS rates, with a mean follow-up time of 41.5 months. AJCC 8th edition prognostic staging was a better predictor of OS than 7th edition anatomic staging for both clinical stage [area under the curve (AUC) 0.67 vs. 0.62, p < 0.01] and pathological stage (AUC 0.70 vs. 0.66, p < 0.01).
CONCLUSIONS: Sixty-five percent of patients have a shift in clinical stage in the AJCC 8th edition. AJCC 8th edition staging has better predictive value for OS than 7th edition staging. While validation of these findings with an independent dataset is needed, 8th edition staging will help improve prognostic modeling in patients undergoing neoadjuvant chemotherapy.
PMID: 31376037
DOI: 10.1245/s10434-019-07636-w
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