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Mittendorf EA, Ballman KV, McCall LM, Yi M, Sahin AA, Bedrosian I, Hansen N, Gabram S, Hurd T, Giuliano AE, Hunt KK. Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer. J Clin Oncol 2014; 33:1119-27. [PMID: 25488970 DOI: 10.1200/jco.2014.57.2958] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer differentiates patients with T1 tumors and lymph node micrometastases (stage IB) from patients with T1 tumors and negative nodes (stage IA). This study was undertaken to determine the utility of the stage IB designation. PATIENTS AND METHODS The following two cohorts of patients with breast cancer were identified: 3,474 patients treated at The University of Texas MD Anderson Cancer Center from 1993 to 2007 and 4,590 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0010 trial. Clinicopathologic and outcomes data were recorded, and disease was staged according to the seventh edition AJCC staging system. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were determined using the Kaplan-Meier method and compared using the log-rank test. RESULTS Median follow-up times were 6.1 years and 9.0 years for the MD Anderson Cancer Center and ACOSOG cohorts, respectively. In both cohorts, there were no significant differences between patients with stage IA and stage IB disease in 5- or 10-year RFS, DSS, or OS. Estrogen receptor (ER) status and grade significantly stratified patients with stage I disease with respect to RFS, DSS, and OS. CONCLUSION Among patients with T1 breast cancer, individuals with micrometastases and those with negative nodes have similar survival outcomes. ER status and grade are better discriminants of survival than the presence of small-volume nodal metastases. In preparing the next edition of the AJCC staging system, consideration should be given to eliminating the stage IB designation and incorporating biologic factors.
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Affiliation(s)
- Elizabeth A Mittendorf
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Karla V Ballman
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Linda M McCall
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Min Yi
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Aysegul A Sahin
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Isabelle Bedrosian
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nora Hansen
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sheryl Gabram
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Thelma Hurd
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Armando E Giuliano
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Kelly K Hunt
- Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA
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