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Validation of the newly proposed American Joint Committee on Cancer (AJCC) breast cancer prognostic staging group and proposing a new staging system using the National Cancer Database

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Abstract

Background

The eighth edition of AJCC cancer staging manual incorporated biomarker status into the prognostic staging group (PSG). We used data from National Cancer Database (NCDB) to validate and improve the PSG.

Methods

All patients had surgery and at least some systemic treatment (endocrine therapy, chemotherapy or HER2 targeted therapy). Information from 420,520 patients was assessed for potential predictors of overall survival (OS), including age at diagnosis (age), tumor grade (G), hormonal receptor and HER2 status, and presence of lymph vascular invasion (LVI), stratified by stage or sub-stages. Based on the multivariate Cox analyses, we built different point systems to predict OS and evaluated the different point systems by Akaike’s information criterion (AIC), Harrell’s concordance index (C-index), and Uno’s concordance index.

Results

Age, G, hormonal receptor and HER2 status, LVI and being TNBC were significantly associated with OS (all P < 0.0001). Three staging systems were correlated with OS: system 1 was the conventional anatomic TNM staging; system 2 included TNM, age, G, hormonal receptor, HER2, and LVI; system 3 included TNM, age, G, TNBC versus non-TNBC, and LVI. System 3 (C-index; 0.7316; AIC: 488138.91) achieved the best balance between predictive performance and goodness-of-fit to the NCDB data as compared to system 2 (C-index: 0.7325; AIC: 498087.73) and system 1 (C-index: 0.716; AIC: 688536.49).

Conclusions

The new PSG is a better staging system than the conventional anatomic TNM system. Grouping breast cancer into TNBC versus non-TNBC may be simpler while retaining similar accuracy as using ER/PR/HER2 status to predict OS.

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Acknowledgements

Research reported in this publication was supported in part by the Winship Research Informatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under Award Number P30CA138292. The data used in the study are derived from a de-identified NCDB file. The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data by the investigator.

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Emory University, 1364 Clifton Road, Suite H175, Atlanta, GA, 30322, USA

    Xiaoxian Li

  2. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA, USA

    Yiran Zhang & Limin Peng

  3. Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA

    Jane Meisel

  4. Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Renjian Jiang & Madhusmita Behera

Authors
  1. Xiaoxian Li
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  2. Yiran Zhang
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  3. Jane Meisel
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  4. Renjian Jiang
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  5. Madhusmita Behera
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  6. Limin Peng
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Contributions

Conception and design: XL, PL. Analysis and interpretation of data: XL, YZ, JM, PL. Manuscript drafting and reviewing: All authors. XL is responsible for the overall content.

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Correspondence to Xiaoxian Li.

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The authors have no financial disclosures or conflicts of interest.

Research involving human and animal participants

This article does not contain any studies with human participants or animals performed by any of the authors.

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Li, X., Zhang, Y., Meisel, J. et al. Validation of the newly proposed American Joint Committee on Cancer (AJCC) breast cancer prognostic staging group and proposing a new staging system using the National Cancer Database. Breast Cancer Res Treat 171, 303–313 (2018). https://doi.org/10.1007/s10549-018-4832-9

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  • DOI: https://doi.org/10.1007/s10549-018-4832-9

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