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Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The American Joint Committee on Cancer (AJCC) breast cancer pathological prognostic stage, which incorporates biologic factors, was developed using data from patients undergoing upfront surgery, and its application in patients receiving neoadjuvant chemotherapy (NAC) is unknown. We previously developed the Neo-Bioscore, incorporating clinical and pathological TNM categories with biologic factors, to improve the prognostic stratification of NAC patients.

Objective

This study was undertaken to evaluate the use of available staging models incorporating biologic factors in NAC patients.

Methods

Patients treated with NAC between 2005 and 2012 at MD Anderson (n = 2363) were staged using the Neo-Bioscore and the AJCC 8th edition: (1) clinical anatomic stage; (2) pathological anatomic stage; (3) clinical prognostic stage; and (4) pathological prognostic stage. Five-year disease-specific survival (DSS) and overall survival (OS) rates, along with Harrell’s concordance index (C-index), were estimated. A National Cancer Database (NCDB) cohort (n = 12,887) treated with NAC between 2010 and 2013 was used for validation.

Results

In the MD Anderson cohort, staging systems incorporating biologic factors better predicted DSS (bias-corrected C-index: pathological prognostic stage = 0.8026; Neo-Bioscore = 0.7483) and OS (bias-corrected C-index: pathological prognostic stage = 0.7780; Neo-Bioscore = 0.7260) than those using anatomic factors only. Similar results were seen in the NCDB cohort. In pairwise comparisons, the pathological prognostic stage was significantly better (p < 0.0001) than other staging systems in all comparisons except for OS in the NCDB cohort, where it was not significantly different than the Neo-Bioscore (p = 0.2).

Conclusion

Biologic factors are important for determining prognosis in patients receiving NAC. These data indicate that the 8th edition AJCC pathological prognostic stage is applicable in these patients.

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Funding

This study was supported in part by the MD Anderson Cancer Center National Cancer Institute Cancer Center support Grant P30 CA016672.

Author information

Authors and Affiliations

  1. Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Min Yi MD, PhD, Isabelle Bedrosian MD & Kelly K. Hunt MD

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Heather Lin PhD & Yu Shen PhD

  3. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariana Chavez-MacGregor MD

  4. Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Mariana Chavez-MacGregor MD

  5. Division of Breast Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA

    Tari A. King MD & Elizabeth A. Mittendorf MD, PhD

  6. Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Tari A. King MD & Elizabeth A. Mittendorf MD, PhD

Authors
  1. Min Yi MD, PhD
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  2. Heather Lin PhD
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  3. Isabelle Bedrosian MD
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  4. Yu Shen PhD
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  5. Kelly K. Hunt MD
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  6. Mariana Chavez-MacGregor MD
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  7. Tari A. King MD
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  8. Elizabeth A. Mittendorf MD, PhD
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Corresponding author

Correspondence to Elizabeth A. Mittendorf MD, PhD.

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Disclosure

Kelly K. Hunt reports compensated participation in medical advisory boards for Armada Health and Merck; Mariana Chavez-MacGregor reports having served as a consultant for Abbott, Eisai, Pfizer and Roche; Tari A. King reports speaker fees from Genomic Health; and Elizabeth A. Mittendorf reports compensated participation in scientific advisory boards for Amgen, Celgene, Astra-Zeneca, Genentech, Genomic Health, Merck, Sellas Life Sciences, and Tapimmune. The other authors have no conflicts of interest to declare.

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Yi, M., Lin, H., Bedrosian, I. et al. Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors. Ann Surg Oncol 27, 359–366 (2020). https://doi.org/10.1245/s10434-019-07983-8

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  • DOI: https://doi.org/10.1245/s10434-019-07983-8

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