1
|
Krecko LK, Neuman HB, Greenberg CC, Wilke LG, Hanlon BM, Edge SB, Ruddy KJ, Partridge AH, Le-Rademacher J, Yang DY, Havlena J, R Schumacher J. Validation of the AJCC 8th Edition Breast Cancer Prognostic Staging System in Legacy Alliance Trials (AFT-01). Ann Surg Oncol 2024; 31:5880-5887. [PMID: 38825628 DOI: 10.1245/s10434-024-15477-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
BACKGROUND The 8th edition American Joint Committee on Cancer staging system combined anatomic stage (AS) with receptor status and grade to create prognostic stage (PS). PS has been validated in single-institution and cancer registry studies; however, missing human epidermal growth factor receptor 2 (HER2) status and variable treatment and follow-up create limitations. OBJECTIVE Our objective was to compare the relative prognostic ability of PS versus AS to predict survival using breast cancer clinical trial data. METHODS Women with non-metastatic breast cancer enrolled in six Alliance for Clinical Trials in Oncology trials were included (enrollment years 1997-2010). AS and PS were constructed using pathological tumor size, nodal status, estrogen receptor (ER), progesterone receptor (PR), HER2 status, and grade. Unadjusted Cox proportional hazard models were estimated to predict overall survival within 5 years, with AS and PS as predictor variables. The relative predictive power of staging models was assessed by comparing Harrell concordance indices (C-indices). Kaplan-Meier-based mortality estimates were compared by stage. RESULTS Overall, 6924 women were included (median age 53 years); 45.2% were diagnosed with ER+/PR+/HER2- tumors, 26.2% with HER2+ tumors, and 17.1% with ER-/PR-/HER2- tumors. Median follow-up time was 5 years (interquartile range 2.95-5.00). PS significantly improved predictive performance (C-index 0.721) for overall survival compared with AS (0.700) (p = 0.020). Kaplan-Meier hazard estimates suggested PS did not distinguish mortality risk between patients with IIB and IIIA or IB and IIA disease. CONCLUSIONS PS has significantly improved predictive performance for OS compared with AS. As systemic therapies evolve, it will be important to re-evaluate the prognostic staging system, particularly for patients with intermediate-stage cancers. CLINICALTRIALS gov Identifier: NCT02171078.
Collapse
Affiliation(s)
- Laura K Krecko
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Heather B Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Caprice C Greenberg
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - Lee G Wilke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Surgery, University of Wisconsin Carbone Cancer Center, Madison, WI, USA
| | - Bret M Hanlon
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Stephen B Edge
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center and University at Buffalo, Buffalo, NY, USA
| | | | - Ann H Partridge
- Department of Medical Oncology, Dana Farber/Partners CancerCare, Boston, MA, USA
| | | | - Dou-Yan Yang
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jeffrey Havlena
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jessica R Schumacher
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
- Department of Surgery, University of Wisconsin Carbone Cancer Center, Madison, WI, USA.
- Department of Surgery, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
2
|
Loggie J, Barnes PJ, Carter MD, Rayson D, Bethune GC. Is Oncotype DX testing informative for breast cancers with low ER expression? A retrospective review from a biomarker testing referral center. Breast 2024; 75:103715. [PMID: 38520994 PMCID: PMC10973721 DOI: 10.1016/j.breast.2024.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024] Open
Abstract
PURPOSE It remains unclear whether patients with HER2-negative, low-estrogen receptor (ER-low)-positive early breast cancer (BC) benefit from Oncotype DX® (ODX) testing. METHODS We conducted a retrospective review of cases referred for ODX testing over a seven-year period from a breast biomarker testing referral center (n = 854). For each case, we recorded the ODX Recurrence Score (RS) along with percentage of ER nuclear positivity and staining intensity on immunohistochemistry. Our criteria for ER-low was defined as ≤10% cells with nuclear positivity and/or weak intensity of staining. Slides from all ER-low cases were reviewed and the reported ODX ER gene scores were recorded. We randomly selected a comparator group of 56 patients with ER > 10% positivity and non-weak staining intensity (ER-high). RESULTS We identified 27 cases (3.2%) that met our criteria for ER-low. Of these, 92.6% had a high RS (>25), and 7.4% had a RS of 25. All cases with ≤10% ER nuclear positivity had a high RS. Most ER-low cases (85.2%) had ODX quantitative ER gene scores in the negative range, whereas all (100%) ER-high cases had positive ER gene scores. CONCLUSION ODX does not appear to add significant additional information to inform treatment decisions for most patients with ER-low BC. Incorporating weak ER staining intensity in addition to low percentage of nuclear positivity identifies about twice as many ER-low patients, although with reduced specificity for high RS. Our study supports the contention that most ER-low early BC should be regarded similarly to ER-negative BC.
Collapse
Affiliation(s)
- John Loggie
- Department of Pathology and Laboratory Medicine, Dalhousie University, 5788 University Ave, Halifax, NS, B3H 1V8, Canada
| | - Penelope J Barnes
- Department of Pathology and Laboratory Medicine, Dalhousie University, 5788 University Ave, Halifax, NS, B3H 1V8, Canada
| | - Michael D Carter
- Department of Pathology and Laboratory Medicine, Dalhousie University, 5788 University Ave, Halifax, NS, B3H 1V8, Canada
| | - Daniel Rayson
- Division of Medical Oncology, Department of Medicine, Dalhousie University, QEII-Bethune Building, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Gillian C Bethune
- Department of Pathology and Laboratory Medicine, Dalhousie University, 5788 University Ave, Halifax, NS, B3H 1V8, Canada.
| |
Collapse
|
3
|
Edahiro T, Ureshino H, Yoshida T, Fukushima N, Ichinohe T. Challenging Diagnosis of Lytic Bone Lesions Between Multiple Myeloma and Bone Metastasis of Primary Breast Cancer. Cureus 2023; 15:e48880. [PMID: 38111446 PMCID: PMC10726101 DOI: 10.7759/cureus.48880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
Lytic bone lesions include various differential diagnoses, such as bone metastasis of cancer, multiple myeloma, primary bone cancers, and infections. Here, we report a rare case of primary breast cancer complicated by lytic bone lesions mimicking bone metastasis, which was subsequently diagnosed as multiple myeloma. Despite the development of several imaging modalities, such as magnetic resonance imaging and positron emission tomography/computed tomography, diagnosing lytic bone lesions with either multiple myeloma or tumor metastasis is highly challenging. Urinalysis is a noninvasive diagnostic method that includes useful diagnostic information; thus, physicians should evaluate urine protein levels when lytic bone lesions are observed.
Collapse
Affiliation(s)
- Tao Edahiro
- Hematology and Oncology, Hiroshima University, Research Institute for Radiation Biology and Medicine, Hiroshima, JPN
| | - Hiroshi Ureshino
- Hematology and Oncology, Hiroshima University, Research Institute for Radiation Biology and Medicine, Hiroshima, JPN
| | - Tetsumi Yoshida
- Hematology and Oncology, Hiroshima University, Research Institute for Radiation Biology and Medicine, Hiroshima, JPN
| | - Noriyasu Fukushima
- Department of Internal Medicine, Karatsu Red Cross Hospital, Karatsu, JPN
| | - Tatsuo Ichinohe
- Hematology and Oncology, Hiroshima University, Research Institute for Radiation Biology and Medicine, Hiroshima, JPN
| |
Collapse
|
4
|
Hemalatha A, Soman P, Nadipanna S, Raju K. Comparison of 7 th and 8 th American Joint Committee on Cancer Tumor-Node-Metastasis staging in infiltrating ductal carcinoma of the breast: A retrospective study. JOURNAL OF RADIATION AND CANCER RESEARCH 2022. [DOI: 10.4103/jrcr.jrcr_30_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Fei F, Zhang K, Siegal GP, Wei S. A simplified breast cancer prognostic score: comparison with the AJCC clinical prognostic staging system. Mod Pathol 2021; 34:2141-2147. [PMID: 34365462 DOI: 10.1038/s41379-021-00890-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 12/23/2022]
Abstract
There have been many breast cancer prognostic models proposed in the last few decades, varying in their methods of development and validation, predictors, outcomes, and patients included. Most models were developed to assess prognostic outcomes for early breast cancers. In this study, we established a simplified prognostic score to predict survival outcomes in all breast cancer patients. A total of 36,152 breast cancer patients diagnosed between 2010 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were used as the training dataset. Multivariate analyses were performed to identify independent factors for disease-specific survival (DSS). A prognostic score was calculated by summing the point values based on the magnitude of the hazard ratio for all independent factors. The authors institutional cohort (n = 4982) was used as the validation dataset. The prognostic score model consisting of histologic grade, ER, PR, HER2, and TNM status demonstrated a similar predictive power when compared to the revised 8th AJCC Clinical Prognostic Staging system in both training and validation datasets, whereas the addition of age and race did not facilitate stratification of prognostic groups. Pairwise comparison of hazard ratios showed a significant difference in all categories when compared to their proximate groups in both prognostic schemes in the SEER database, while the prognostic score model demonstrated a slightly better discriminating power in the validation dataset. Thus, the proposed prognostic score showed at least a comparable predicting power for survival outcomes in breast cancer patients receiving standard-of-care treatment when compared to the AJCC Clinical Prognostic Stage. This prognostic model provides a convenient and alternative modality in clinical practice thus warranting further validation using larger cohorts with longer follow-up.
Collapse
Affiliation(s)
- Fei Fei
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kui Zhang
- Department of Mathematical Sciences, Michigan Technological University, Houghton, MI, USA
| | - Gene P Siegal
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shi Wei
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, USA.
| |
Collapse
|
6
|
Fei F, Siegal GP, Wei S. Characterization of estrogen receptor-low-positive breast cancer. Breast Cancer Res Treat 2021; 188:225-235. [PMID: 33694051 DOI: 10.1007/s10549-021-06148-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/12/2021] [Indexed: 01/09/2023]
Abstract
PURPOSE The biology of breast cancer with a low expression level (1-10%) of estrogen receptor (ER) remains a matter of confusion. The recent American Society of Oncology/College of American Pathologist Guidelines have recommended reporting such tumors as a new "ER-low-positive" category with a recommended comment to emphasize the possible overall benefit of endocrine therapies in these patients. The aim of the study was to analyze the clinicopathologic features and clinical outcomes of ER-low-positive breast cancers. METHODS We characterized the clinicopathologic features and survival outcomes of ER-low-positive breast cancers in our 4179 patients diagnosed from 1998 to 2018. RESULTS The ER-positive, ER-low-positive, and ER-negative cases in our cohort were 2982 (71.4%), 97 (2.3%), and 1100 (26.3%), respectively. ER-low-positive tumors showed similar clinicopathologic characteristics yet significantly superior prognosis when compared to ER-negative tumors, while demonstrated largely overlapping survival outcomes with ER-positive tumors in the entire cohort. In the subcohort of tumors with a PR-positive phenotype, the prognosis of ER-low-positive tumors was intermediate between that of the ER-positive and ER-negative groups. ER-low-positive/PR-positive tumors had a significantly worse prognosis than ER-positive tumors, and a trend toward favorable survival outcomes when compared to ER-negative tumors, although no significant difference was identified for the latter. In contrast, the ER-positive and ER-low-positive groups showed similar survival outcomes in the subset of tumors with a PR-negative status, both being significantly better than ER-negative tumors. CONCLUSIONS PR status as a surrogate marker of functional ER signaling provides critical information in this regard. These findings suggest that while ER-low-positive tumors are themselves heterogeneous, they often respond to endocrine treatment. Analysis of molecular signatures and standardization of therapeutic strategies are important to understand the biology of ER-low-positive tumors and to enable optimal treatment in the pursuit of individualized medicine.
Collapse
Affiliation(s)
- Fei Fei
- Department of Pathology, University of Alabama at Birmingham, NP 3545, 619 19th St. South, Birmingham, AL, 35249-7331, USA
| | - Gene P Siegal
- Department of Pathology, University of Alabama at Birmingham, NP 3545, 619 19th St. South, Birmingham, AL, 35249-7331, USA.,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, 35249, USA
| | - Shi Wei
- Department of Pathology, University of Alabama at Birmingham, NP 3545, 619 19th St. South, Birmingham, AL, 35249-7331, USA. .,O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL, 35249, USA.
| |
Collapse
|