Olga Kantor1,2, Tari A King1,2,3, Steven Shak4, Christy A Russell4, Armando E Giuliano5, Gabriel N Hortobagyi6, Harold J Burstein2,3,7, Eric P Winer2,3,7, Tanujit Dey8, Joseph A Sparano9, Elizabeth A Mittendorf1,2,3. 1. Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, MA. 2. Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, MA. 3. Harvard Medical School, Boston, MA. 4. Exact Sciences Corp, Redwood City, CA. 5. Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. 6. Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. 7. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA. 8. Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. 9. Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
Abstract
BACKGROUND: The prognostic significance of patients with low-risk Recurrence Score (RS) results in the context of the American Joint Committee on Cancer (AJCC) 8th-edition pathologic prognostic staging has not been investigated. We evaluated if expanded RS criteria can be considered for downstaging in AJCC pathologic prognostic staging. METHODS: Using Surveillance, Epidemiology, and End Results data we identified patients with T1-3N0-3M0 HR-positive/HER2-negative breast cancer treated from 2010-2015 with follow-up data through 2016. We evaluated TNM categories, grade, and RS result. The primary outcome measured was 5-year disease-specific survival (DSS) of patients with low-risk RS results not already pathologic prognostic stage IA, determined by T and N categories per AJCC 8th edition. All statistical tests were 2-sided. RESULTS: Of 154,050 patients with median follow-up of 49 months (range = 0-83), RS results were obtained in 60,886 (39.5%): RS was <11 in 13,570 (22.3%), 11-17 in 22,719 (37.3%), 18-25 in 16,521 (27.1%), and ≥ 26 in 8,076 (13.3%). Five-year DSS for pathologic prognostic stage IA patients (n = 114,910, 74.6%) was 98.8%. Among N0-1 patients with RS < 18 not staged as pathologic prognostic stage IA by current criteria, 5-year DSS was excellent and not statistically significantly different than for pathologic prognostic stage IA patients (97.2%-99.7%, P > .05). For those with RS 18-25, there was a small decrease in DSS for T2N0 (2.3%) and modest decrease for T1-2N1 (4.2%-6.4%) compared to pathologic prognostic stage IA patients (P < .001). CONCLUSION: Patients with RS < 18 have excellent 5-year DSS regardless of T category for N0-1 disease suggesting further modification of the AJCC staging system using this cutoff.
BACKGROUND: The prognostic significance of patients with low-risk Recurrence Score (RS) results in the context of the American Joint Committee on Cancer (AJCC) 8th-edition pathologic prognostic staging has not been investigated. We evaluated if expanded RS criteria can be considered for downstaging in AJCC pathologic prognostic staging. METHODS: Using Surveillance, Epidemiology, and End Results data we identified patients with T1-3N0-3M0 HR-positive/HER2-negative breast cancer treated from 2010-2015 with follow-up data through 2016. We evaluated TNM categories, grade, and RS result. The primary outcome measured was 5-year disease-specific survival (DSS) of patients with low-risk RS results not already pathologic prognostic stage IA, determined by T and N categories per AJCC 8th edition. All statistical tests were 2-sided. RESULTS: Of 154,050 patients with median follow-up of 49 months (range = 0-83), RS results were obtained in 60,886 (39.5%): RS was <11 in 13,570 (22.3%), 11-17 in 22,719 (37.3%), 18-25 in 16,521 (27.1%), and ≥ 26 in 8,076 (13.3%). Five-year DSS for pathologic prognostic stage IA patients (n = 114,910, 74.6%) was 98.8%. Among N0-1 patients with RS < 18 not staged as pathologic prognostic stage IA by current criteria, 5-year DSS was excellent and not statistically significantly different than for pathologic prognostic stage IA patients (97.2%-99.7%, P > .05). For those with RS 18-25, there was a small decrease in DSS for T2N0 (2.3%) and modest decrease for T1-2N1 (4.2%-6.4%) compared to pathologic prognostic stage IA patients (P < .001). CONCLUSION: Patients with RS < 18 have excellent 5-year DSS regardless of T category for N0-1 disease suggesting further modification of the AJCC staging system using this cutoff.
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