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Published on: May 17, 2019
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Are All Prognostic Stage IB Breast Cancers Equivalent?
Stephanie M Yoon1, Shengyang Wu2, Amanda Schwer3
1Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA 91010, USA.
Cancers
|November 27, 2024
Summary
Locally advanced hormone-receptor-positive/HER2-negative breast cancer (LA-HR+/HER2-) has worse survival than early-stage triple-negative breast cancer (ES-TNBC), despite both being Pathologic Prognostic Stage IB. Anatomic extent, not just subtype, impacts breast cancer prognosis.
Area of Science:
- Oncology
- Cancer Staging
- Breast Cancer Research
Background:
- The 8th edition of the American Joint Committee on Cancer's Pathologic Prognostic Staging (PPS) integrates anatomic extent, histology, and biomarker status for breast cancer (BC).
- PPS IB currently includes both locally advanced hormone-receptor-positive/HER2-negative (LA-HR+/HER2-) BC and early-stage triple-negative BC (ES-TNBC), despite differing biological characteristics.
- Nodal involvement is a critical prognostic factor, prompting investigation into whether biological subtype or anatomic stage is more influential in discordant PPS IB cases.
Purpose of the Study:
- To test the hypothesis that overall survival (OS) is worse for LA-HR+/HER2- BC compared to ES-TNBC, even when both are classified as PPS IB.
- To evaluate the prognostic impact of anatomic stage versus biological subtype in breast cancer patients within the same PPS IB category.
Main Methods:
- Utilized the National Cancer Database to identify patients with LA-HR+/HER2- BC (pT3N1 or pT1-3N2, grade 1-2) and ES-TNBC (T1N0, grade 2-3) treated between 2004 and 2017.
- Excluded patients lacking complete staging, biomarker data, grade, TNM staging, or those who received neoadjuvant therapy.
- Employed multivariable Cox regression to compare overall survival (OS) between the two groups.
Main Results:
- Analysis of 45,818 patients revealed significantly worse 6-year OS for LA-HR+/HER2- BC (86.1%) compared to ES-TNBC (90.4%) (HR = 1.63; p < 0.0001).
- Among patients receiving appropriate therapies, LA-HR+/HER2- BC demonstrated a 35% relatively higher risk of death (HR = 1.35; p < 0.0001).
- These findings indicate poorer survival for LA-HR+/HER2- BC despite identical PPS IB classification and treatment.
Conclusions:
- Anatomic disease extent remains a crucial prognostic factor in breast cancer patients with discordant anatomic stage and PPS.
- The current PPS IB classification may not accurately reflect survival outcomes for LA-HR+/HER2- BC.
- Future PPS revisions should consider re-classifying LA-HR+/HER2- BC to provide more precise prognostic and survival information.
