Validation of a Novel Staging System for Disease-Specific Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy
Validation of a Novel Staging System for Disease-Specific Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy
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DOI：
10.1200/jco.2010.31.8469
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发表时间：
2011-05-20
影响因子：
45.3
通讯作者：
Hunt, Kelly K.
中科院分区：
文献类型：
--
作者：
Mittendorf, Elizabeth A.;Jeruss, Jacqueline S.;Hunt, Kelly K.
目的我们先前描述了一种新的乳腺癌分期系统，用于评估新辅助化疗后的预后，该系统基于治疗前临床分期（CS）、雌激素受体状态（E）、分级（G）和治疗后病理分期（PS）。这种临床病理分期（CPS）+ EG分期系统为每个因素分配并求和，与单独的CS或PS相比，可以更好地确定乳腺癌特异性生存率。目前的研究进行，以验证这一分期系统使用内部和外部cohols.MethodsWe确定了一个内部队列的804例新辅助化疗治疗患者在我们的机构从2003年至2005年和外部队列的165例患者在另一个机构治疗。对临床病理特征、治疗方案和患者结局进行评估。结果分层CPS + EG score.Results5年疾病特异性生存（DSS）的内部队列为77%（95%CI，72至82），中位随访时间为3.4年（范围，0.3至5.9年）。中位随访时间为4.7年（范围：0.5 - 10.5年）时，外部队列的5年DSS为86%（95% CI，79 - 91）。CPS + EG评分对结局进行分层的能力在内部和外部队列中均得到证实。CPS + EG分期系统的应用促进了更精细的分类患者预后亚组的结果比提出CS或最终PS定义的美国癌症联合委员会（AJCC）分期系统。结论本研究在两个独立的队列中验证了CPS + EG分期系统。我们建议将生物标志物和治疗反应纳入新辅助化疗患者AJCC分期系统的修订版本中。J Clin Oncol 29：1956-1962. (C)2011年美国临床肿瘤学会
PurposeWe previously described a novel breast cancer staging system for assessing prognosis after neoadjuvant chemotherapy on the basis of pretreatment clinical stage (CS), estrogen receptor status (E), grade (G), and post-treatment pathologic stage (PS). This clinical-pathologic stage (CPS) + EG staging system assigned and summed points for each factor, allowing for better determination of breast cancer-specific survival than CS or PS alone. The current study was undertaken to validate this staging system using internal and external cohorts.MethodsWe identified an internal cohort of 804 patients treated with neoadjuvant chemotherapy at our institution from 2003 to 2005 and an external cohort of 165 patients treated at another institution. Clinicopathologic characteristics, treatment regimens, and patient outcomes were assessed. Outcomes were stratified by CPS + EG score.ResultsFive-year disease-specific survival (DSS) for the internal cohort was 77% (95% CI, 72 to 82) at a median follow-up of 3.4 years (range, 0.3 to 5.9 years). Five-year DSS for the external cohort was 86% (95% CI, 79 to 91) at a median follow-up of 4.7 years (range, 0.5 to 10.5 years). The ability of the CPS + EG score to stratify outcomes was confirmed in both the internal and external cohorts. Application of the CPS + EG staging system facilitated more refined categorization of patients into prognostic subgroups by outcome than presenting CS or final PS as defined by the American Joint Committee on Cancer (AJCC) staging system. ConclusionThe current study validates the CPS + EG staging system in two independent cohorts. We recommend that biologic markers and response to treatment be incorporated into revised versions of the AJCC staging system for patients receiving neoadjuvant chemotherapy. J Clin Oncol 29:1956-1962. (C) 2011 by American Society of Clinical Oncology