Is the TNM Staging System for Breast Cancer Still Relevant in the Era of Biomarkers and Emerging Personalized Medicine for Breast Cancer - An Institution's 10-year Experience

2015 ◽  
Vol 21 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Amila Orucevic ◽  
Jason Chen ◽  
James M. McLoughlin ◽  
Robert E. Heidel ◽  
Timothy Panella ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Personalized Medicine ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System

New and Important Changes in the TNM Staging System for Breast Cancer

2018 ◽  
pp. 457-467 ◽  
Author(s):  
Gabriel N. Hortobagyi ◽  
Stephen B. Edge ◽  
Armando Giuliano
Keyword(s):  
Breast Cancer ◽  
Regional Lymph Node ◽  
Staging System ◽  
Distant Metastases ◽  
Tnm Staging ◽  
Pathology Report ◽  
Imaging Evaluation ◽  
Complete Surgical Excision ◽  
Tnm Staging System ◽  
Eighth Edition

Expanded understanding of biologic factors that modulate the clinical course of malignant disease have led to the gradual integration of biomarkers into staging classifications. The American Joint Committee on Cancer (AJCC) TNM staging system is universally used and has largely displaced other staging classifications for most, although not all, cancers. Many of the chapters of the eighth edition of the AJCC TNM staging system integrated biomarkers with anatomic definitions. The Breast Chapter added estrogen receptor (ER) and progesterone receptor (PR) expression, HER2 expression, and/or amplification and histologic grade to the anatomic assessment of tumor size, regional lymph node involvement, and distant metastases (known as TNM). While preserving an anatomic staging system for continuity and for regions where modern biomarkers are not always available, the eighth edition emphasizes the increased prognostic precision of the clinical prognostic stage groups and the pathologic prognostic stage groups. The clinical prognostic stage groups are applicable to all patients with primary breast cancer before any treatment has been implemented, but require a clinical and imaging evaluation as well as a biopsy with grade and available ER, PR, and HER2 results; the pathologic prognostic stage groups are applicable to all patients treated with complete surgical excision as first treatment and also require a complete pathology report, grade, and ER, PR, and HER2. Applying the pathologic prognostic stage groups to a large database of patients staged by basic TNM groupings changed the stage grouping of almost 40% of patients. Grouping by pathologic prognostic stage groups led to a better prognostic distribution of the group and more precise individual prognostication.

scholarly journals Inflammatory breast cancer: a proposed conceptual shift in the UICC–AJCC TNM staging system

2017 ◽  
Vol 18 (4) ◽  
pp. e228-e232 ◽  
Author(s):  
Tamer M Fouad ◽  
Angelica M Gutierrez Barrera ◽  
James M Reuben ◽  
Anthony Lucci ◽  
Wendy A Woodward ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Inflammatory Breast Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Conceptual Shift

The 2003 Revised TNM Staging System for Breast Cancer: Results of Stage Re-classification on Survival and Future Comparisons among Stage Groups

2006 ◽  
Vol 14 (1) ◽  
pp. 143-147 ◽  
Author(s):  
Pedro F Escobar ◽  
Rebecca J Patrick ◽  
Lisa A Rybicki ◽  
David E Weng ◽  
Joseph P Crowe
Keyword(s):  
Breast Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System

scholarly journals Molecular characterization of breast cancer: a potential novel immune-related lncRNAs signature

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Jianguo Lai ◽  
Bo Chen ◽  
Guochun Zhang ◽  
Xuerui Li ◽  
Hsiaopei Mok ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Stratification ◽  
Cox Regression ◽  
Predictive Accuracy ◽  
Expression Profiles ◽  
Treatment Strategies ◽  
Staging System ◽  
Tnm Staging ◽  
The Cancer Genome Atlas ◽  
Tnm Staging System

Abstract Background Accumulating evidence has demonstrated that immune-related lncRNAs (IRLs) are commonly aberrantly expressed in breast cancer (BC). Thus, we aimed to establish an IRL-based tool to improve prognosis prediction in BC patients. Methods We obtained IRL expression profiles in large BC cohorts (N = 911) from The Cancer Genome Atlas (TCGA) database. Then, in light of the correlation between each IRL and recurrence-free survival (RFS), we screened prognostic IRL signatures to construct a novel RFS nomogram via a Cox regression model. Subsequently, the performance of the IRL-based model was evaluated through discrimination, calibration ability, risk stratification ability and decision curve analysis (DCA). Results A total of 52 IRLs were obtained from TCGA. Based on multivariate Cox regression analyses, four IRLs (A1BG-AS1, AC004477.3, AC004585.1 and AC004854.2) and two risk parameters (tumor subtype and TNM stage) were utilized as independent indicators to develop a novel prognostic model. In terms of predictive accuracy, the IRL-based model was distinctly superior to the TNM staging system (AUC: 0.728 VS 0.673, P = 0.010). DCA indicated that our nomogram had favorable clinical practicability. In addition, risk stratification analysis showed that the IRL-based tool efficiently divided BC patients into high- and low-risk groups (P < 0.001). Conclusions A novel IRL-based model was constructed to predict the risk of 5-year RFS in BC. Our model can improve the predictive power of the TNM staging system and identify high-risk patients with tumor recurrence to implement more appropriate treatment strategies.

scholarly journals A Nomogram for Predicting Survival in Patients With Breast Cancer Liver Metastasis: A Population-Based Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yu Xiong ◽  
Xia Shi ◽  
Qi Hu ◽  
Xingwei Wu ◽  
Enwu Long ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prognostic Factors ◽  
Liver Metastasis ◽  
Risk Stratification ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System ◽  
Stratification System ◽  
Breast Cancer Liver Metastasis ◽  
Risk Stratification System

ObjectiveThe prognosis of patients with breast cancer liver metastasis (BCLM) was poor. We aimed at constructing a nomogram to predict overall survival (OS) for BCLM patients using the SEER (Surveillance Epidemiology and End Results) database, thus choosing an optimized therapeutic regimen to treat.MethodsWe identified 1173 patients with BCLM from the SEER database and randomly divided them into training (n=824) and testing (n=349) cohorts. The Cox proportional hazards model was applied to identify independent prognostic factors for BCLM, based on which a nomogram was constructed to predict 1-, 2-, and 3-year OS. Its discrimination and calibration were evaluated by the Concordance index (C-index) and calibration plots, while the accuracy and benefits were assessed by comparing it to AJCC-TNM staging system using the decision curve analysis (DCA). Kaplan-Meier survival analyses were applied to test the clinical utility of the risk stratification system.ResultsGrade, marital status, surgery, radiation therapy, chemotherapy, CS tumor size, tumor subtypes, bone metastatic, brain metastatic, and lung metastatic were identified to be independent prognostic factors of OS. In comparison with the AJCC-TNM staging system, an improved C-index was obtained (training group: 0.701 vs. 0.557, validation group: 0.634 vs. 0.557). The calibration curves were consistent between nomogram-predicted survival probability and actual survival probability. Additionally, the DCA curves yielded larger net benefits than the AJCC-TNM staging system. Finally, the risk stratification system can significantly distinguish the ones with different survival risk based on the different molecular subtypes.ConclusionWe have successfully built an effective nomogram and risk stratification system to predict OS in BCLM patients, which can assist clinicians in choosing the appropriate treatment strategies for individual BCLM patients.

Abstract P6-08-15: Deconstructing the TNM staging system for breast cancer

2015 ◽  
Author(s):  
Jigar A Patel ◽  
Matthew T Hueman ◽  
Dechang Chen ◽  
Donald E Henson
Keyword(s):  
Breast Cancer ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System

scholarly journals Clinical relevance of TNM staging system according to breast cancer subtypes

2011 ◽  
Vol 22 (7) ◽  
pp. 1554-1560 ◽  
Author(s):  
Y.H. Park ◽  
S.J. Lee ◽  
E.Y. Cho ◽  
Y.La. Choi ◽  
J.E. Lee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Relevance ◽  
Staging System ◽  
Tnm Staging ◽  
Breast Cancer Subtypes ◽  
Cancer Subtypes ◽  
Tnm Staging System

scholarly journals Multifocality, Multicentricity, and Bilaterality of Breast Cancer

2021 ◽  
Author(s):  
Ivan Ilić
Keyword(s):  
Breast Cancer ◽  
Treatment Decision ◽  
Staging System ◽  
Tnm Staging ◽  
Breast Cancers ◽  
Precursor Lesions ◽  
Tnm Staging System ◽  
Practical Guidance ◽  
Multifocal Disease ◽  
Treatment Procedures

Multifocal, multicentric, and bilateral breast tumours are either benign, precursor lesions or malignant neoplasms.A multidisciplinary review of these entities can offer clinicians a practical guidance for diagnostic and treatment procedures. Multiple synchronous (multifocal or multicentric) ipsilateral breast cancers (MSIBC) with heterogeneous histopathology require particular attention, since MSIBC tends toward more aggressive biology and higher rates of nodal positivity. Being independent of laterality, domination of the invasive carcinoma was observed in the bilateral and multifocal disease type. The TNM staging system for breast cancer does not include multifocality and multiplicity. Only the tumour with the largest diameter is considered for the pT category, neglecting the secondary foci which can make the treatment decision more difficult. MSIBC has a similar prognosis to unifocal cancers, but sometimes they might be negative prognostic parameters. Likewise, in comparison with unifocal breast cancer, MSIBC presents a different genetic pathway.

Clinical relevance of TNM staging system according to breast cancer (BC) subtypes.

2010 ◽  
Vol 28 (15_suppl) ◽  
pp. 632-632
Author(s):  
Y. Park ◽  
S. Lee ◽  
J. Kong ◽  
E. Cho ◽  
Y. Choi ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Relevance ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System
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