Breast Cancer-Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual
Breast Cancer-Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual
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DOI：
10.3322/caac.21393
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发表时间：
2017-07-01
影响因子：
254.7
通讯作者：
Hortobagyi, Gabriel N.
中科院分区：
文献类型：
--
作者：
Giuliano, Armando E.;Connolly, James L.;Hortobagyi, Gabriel N.
美国癌症联合委员会（AJCC）乳腺癌原发性肿瘤、淋巴结和转移（TNM）分类第八版的修订是由乳腺癌专家多学科团队确定的。该小组认识到需要将生物学因素，如肿瘤分级、增殖率、雌激素和孕激素受体表达、人表皮生长因子2（HER2）表达和基因表达预后小组纳入分期系统。尽可能遵循AJCC证据水平和所有肿瘤类型的指南。专家组认为，为了保持世界范围的价值，肿瘤分期系统应继续基于TNM解剖因素。然而，认识到分级、激素受体表达和HER2扩增的预后影响，要求将其纳入分期系统。商业上可获得的基于基因的测定的价值得到了认可，并增加了预后输入。肿瘤生物标志物和低Oncotype DX复发评分可改变预后和分期。这些更新预计将为分期系统提供额外的精确性和灵活性，并基于已发表信息的范围和对尚未发表的大型数据库的分析。AJCC TNM分期系统的第八版，因此，提供了一个灵活的平台，预后分类的基础上，传统的解剖因素，可以修改和增强使用患者的生物标志物和多因素的预后面板数据。第八版仍然是乳腺癌分期的全球基础，并将纳入未来的在线更新，以保持及时性和相关性。(C)2017美国癌症协会
The revision of the eighth edition of the primary tumor, lymph node, and metastasis (TNM) classification of the American Joint Commission of Cancer (AJCC) for breast cancer was determined by a multidisciplinary team of breast cancer experts. The panel recognized the need to incorporate biologic factors, such as tumor grade, proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression prognostic panels into the staging system. AJCC levels of evidence and guidelines for all tumor types were followed as much as possible. The panel felt that, to maintain worldwide value, the tumor staging system should remain based on TNM anatomic factors. However, the recognition of the prognostic influence of grade, hormone receptor expression, and HER2 amplification mandated their inclusion into the staging system. The value of commercially available, gene-based assays was acknowledged and prognostic input added. Tumor biomarkers and low Oncotype DX recurrence scores can alter prognosis and stage. These updates are expected to provide additional precision and flexibility to the staging system and were based on the extent of published information and analysis of large, as yet unpublished databases. The eighth edition of the AJCC TNM staging system, thus, provides a flexible platform for prognostic classification based on traditional anatomic factors, which can be modified and enhanced using patient biomarkers and multifactorial prognostic panel data. The eighth edition remains the worldwide basis for breast cancer staging and will incorporate future online updates to remain timely and relevant. (C) 2017 American Cancer Society.