Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors
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 previo...
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| Veröffentlicht in: | Annals of surgical oncology 2020-02, Vol.27 (2), p.359-366 |
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| creator | Yi, Min Lin, Heather Bedrosian, Isabelle Shen, Yu Hunt, Kelly K. Chavez-MacGregor, Mariana King, Tari A. Mittendorf, Elizabeth A. |
| description | 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
|
| doi_str_mv | 10.1245/s10434-019-07983-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2343346246</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2343346246</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-8ffb6de1c1252a7e4b6e6d162bdad844e606c0e23fde5b81bdc67a1c24bc3ab93</originalsourceid><addsrcrecordid>eNp9kM1OAjEURhujEURfwIVp4nq0f9MZ3AkRJSFqVNZNp3MHhsB0bAsJb28R1J2r29ye77vJQeiSkhvKRHrrKRFcJIT2E5L1c57kR6hL07gSMqfH8U1knvSZTDvozPsFITTjJD1FHU6lzDJGu6h9D3pWNzNcWYcHDrQPeKgbAw6_6lBDEzx-AwP1Zgc9g9XlYr3RTaTmsLJhDk632zs8DfWyDltsKzxujHWtdTEeI4PaLu2sNnikTbDOn6OTSi89XBxmD01HDx_Dp2Ty8jge3k8Sw7M0JHlVFbIEaihLmc5AFBJkSSUrSl3mQoAk0hBgvCohLXJalEZmmhomCsN10ec9dL3vbZ39XIMPamHXroknFeOCcyGZkJFie8o4672DSrWuXmm3VZSonWS1l6yiZPUtWeUxdHWoXhcrKH8jP1YjwPeAj1_NDNzf7X9qvwDk_onn</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2343346246</pqid></control><display><type>article</type><title>Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Yi, Min ; Lin, Heather ; Bedrosian, Isabelle ; Shen, Yu ; Hunt, Kelly K. ; Chavez-MacGregor, Mariana ; King, Tari A. ; Mittendorf, Elizabeth A.</creator><creatorcontrib>Yi, Min ; Lin, Heather ; Bedrosian, Isabelle ; Shen, Yu ; Hunt, Kelly K. ; Chavez-MacGregor, Mariana ; King, Tari A. ; Mittendorf, Elizabeth A.</creatorcontrib><description>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.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-019-07983-8</identifier><identifier>PMID: 31667721</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antineoplastic Combined Chemotherapy Protocols - therapeutic use ; Biomarkers, Tumor - metabolism ; Breast cancer ; Breast Neoplasms - drug therapy ; Breast Neoplasms - metabolism ; Breast Neoplasms - pathology ; Breast Oncology ; Chemotherapy ; Female ; Follow-Up Studies ; Humans ; Medical prognosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoadjuvant Therapy - mortality ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local - drug therapy ; Neoplasm Recurrence, Local - metabolism ; Neoplasm Recurrence, Local - pathology ; Neoplasm Staging - standards ; Oncology ; Patients ; Prospective Studies ; Receptor, ErbB-2 - metabolism ; Receptors, Estrogen - metabolism ; Receptors, Progesterone - metabolism ; ROC Curve ; Surgery ; Surgical Oncology ; Survival ; Survival Rate ; Young Adult</subject><ispartof>Annals of surgical oncology, 2020-02, Vol.27 (2), p.359-366</ispartof><rights>Society of Surgical Oncology 2019</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-8ffb6de1c1252a7e4b6e6d162bdad844e606c0e23fde5b81bdc67a1c24bc3ab93</citedby><cites>FETCH-LOGICAL-c375t-8ffb6de1c1252a7e4b6e6d162bdad844e606c0e23fde5b81bdc67a1c24bc3ab93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-019-07983-8$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-019-07983-8$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31667721$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yi, Min</creatorcontrib><creatorcontrib>Lin, Heather</creatorcontrib><creatorcontrib>Bedrosian, Isabelle</creatorcontrib><creatorcontrib>Shen, Yu</creatorcontrib><creatorcontrib>Hunt, Kelly K.</creatorcontrib><creatorcontrib>Chavez-MacGregor, Mariana</creatorcontrib><creatorcontrib>King, Tari A.</creatorcontrib><creatorcontrib>Mittendorf, Elizabeth A.</creatorcontrib><title>Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Biomarkers, Tumor - metabolism</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - metabolism</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Oncology</subject><subject>Chemotherapy</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - mortality</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Recurrence, Local - drug therapy</subject><subject>Neoplasm Recurrence, Local - metabolism</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neoplasm Staging - standards</subject><subject>Oncology</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Receptor, ErbB-2 - metabolism</subject><subject>Receptors, Estrogen - metabolism</subject><subject>Receptors, Progesterone - metabolism</subject><subject>ROC Curve</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kM1OAjEURhujEURfwIVp4nq0f9MZ3AkRJSFqVNZNp3MHhsB0bAsJb28R1J2r29ye77vJQeiSkhvKRHrrKRFcJIT2E5L1c57kR6hL07gSMqfH8U1knvSZTDvozPsFITTjJD1FHU6lzDJGu6h9D3pWNzNcWYcHDrQPeKgbAw6_6lBDEzx-AwP1Zgc9g9XlYr3RTaTmsLJhDk632zs8DfWyDltsKzxujHWtdTEeI4PaLu2sNnikTbDOn6OTSi89XBxmD01HDx_Dp2Ty8jge3k8Sw7M0JHlVFbIEaihLmc5AFBJkSSUrSl3mQoAk0hBgvCohLXJalEZmmhomCsN10ec9dL3vbZ39XIMPamHXroknFeOCcyGZkJFie8o4672DSrWuXmm3VZSonWS1l6yiZPUtWeUxdHWoXhcrKH8jP1YjwPeAj1_NDNzf7X9qvwDk_onn</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Yi, Min</creator><creator>Lin, Heather</creator><creator>Bedrosian, Isabelle</creator><creator>Shen, Yu</creator><creator>Hunt, Kelly K.</creator><creator>Chavez-MacGregor, Mariana</creator><creator>King, Tari A.</creator><creator>Mittendorf, Elizabeth A.</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20200201</creationdate><title>Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors</title><author>Yi, Min ; Lin, Heather ; Bedrosian, Isabelle ; Shen, Yu ; Hunt, Kelly K. ; Chavez-MacGregor, Mariana ; King, Tari A. ; Mittendorf, Elizabeth A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-8ffb6de1c1252a7e4b6e6d162bdad844e606c0e23fde5b81bdc67a1c24bc3ab93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Biomarkers, Tumor - metabolism</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - metabolism</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Oncology</topic><topic>Chemotherapy</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - mortality</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Recurrence, Local - drug therapy</topic><topic>Neoplasm Recurrence, Local - metabolism</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neoplasm Staging - standards</topic><topic>Oncology</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Receptor, ErbB-2 - metabolism</topic><topic>Receptors, Estrogen - metabolism</topic><topic>Receptors, Progesterone - metabolism</topic><topic>ROC Curve</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yi, Min</creatorcontrib><creatorcontrib>Lin, Heather</creatorcontrib><creatorcontrib>Bedrosian, Isabelle</creatorcontrib><creatorcontrib>Shen, Yu</creatorcontrib><creatorcontrib>Hunt, Kelly K.</creatorcontrib><creatorcontrib>Chavez-MacGregor, Mariana</creatorcontrib><creatorcontrib>King, Tari A.</creatorcontrib><creatorcontrib>Mittendorf, Elizabeth A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yi, Min</au><au>Lin, Heather</au><au>Bedrosian, Isabelle</au><au>Shen, Yu</au><au>Hunt, Kelly K.</au><au>Chavez-MacGregor, Mariana</au><au>King, Tari A.</au><au>Mittendorf, Elizabeth A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>27</volume><issue>2</issue><spage>359</spage><epage>366</epage><pages>359-366</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><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.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>31667721</pmid><doi>10.1245/s10434-019-07983-8</doi><tpages>8</tpages></addata></record> |
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| ispartof | Annals of surgical oncology, 2020-02, Vol.27 (2), p.359-366 |
| issn | 1068-9265 1534-4681 |
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| subjects | Adolescent Adult Aged Aged, 80 and over Antineoplastic Combined Chemotherapy Protocols - therapeutic use Biomarkers, Tumor - metabolism Breast cancer Breast Neoplasms - drug therapy Breast Neoplasms - metabolism Breast Neoplasms - pathology Breast Oncology Chemotherapy Female Follow-Up Studies Humans Medical prognosis Medicine Medicine & Public Health Middle Aged Neoadjuvant Therapy - mortality Neoplasm Invasiveness Neoplasm Recurrence, Local - drug therapy Neoplasm Recurrence, Local - metabolism Neoplasm Recurrence, Local - pathology Neoplasm Staging - standards Oncology Patients Prospective Studies Receptor, ErbB-2 - metabolism Receptors, Estrogen - metabolism Receptors, Progesterone - metabolism ROC Curve Surgery Surgical Oncology Survival Survival Rate Young Adult |
| title | Staging for Breast Cancer Patients Receiving Neoadjuvant Chemotherapy: Utility of Incorporating Biologic Factors |
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