ArticleJournal of clinical oncology : official journal of the American Society of Clinical Oncology2011
Novel staging system for predicting disease-specific survival in patients with breast cancer treated with surgery as the first intervention: time to modify the current American Joint Committee on Cancer staging system.
Article in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
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Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Association of progesterone receptor status with breast cancer prognosis: a meta-analysis.World journal of surgical oncology · 2025Pooled it
- Racial disparities in chemotherapy administration for early-stage breast cancer: a systematic review and meta-analysis.Breast cancer research and treatment · 2018Pooled it
- Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial.Annals of surgery · 2012Trial
- Pretreatment Axillary Nodal Volume as a Prognostic Factor for Breast Cancer.The breast journal · 2025Article
- Relative burden of cancer and noncancer mortality among long-term survivors of differentiated thyroid cancer in the US.Frontiers in endocrinology · 2024Article
- PET/CT and SPECT/CT Imaging of HER2-Positive Breast Cancer.Journal of clinical medicine · 2023Review
- Relative Burden of Cancer and Noncancer Mortality Among Long-Term Survivors of Breast, Prostate, and Colorectal Cancer in the US.JAMA network open · 2023Article
- A prospective cohort study of clinical characteristics and outcomes in Chinese patients with estrogen receptor-negative/progesterone receptor-positive early breast cancer.Breast cancer research and treatment · 2023Article
- Combination of Anatomical and Biological Factors to Predict Disease-Free Survival in Breast Cancer.JCO global oncology · 2023Article
- Applying a neoscore in locally advanced rectal cancer is beneficial in predicting local recurrences after surgery.PloS one · 2023Article
- Correlation between contrast-enhanced cone-beam breast computed tomography features and prognostic staging in breast cancer.The British journal of radiology · 2022Article
- Pathologic method for extracting good prognosis group in triple-negative breast cancer after neoadjuvant chemotherapy.Cancer science · 2022Article
- MRI-Based Radiomics for Preoperative Prediction of Lymphovascular Invasion in Patients With Invasive Breast Cancer.Frontiers in oncology · 2022Article
- Validation of the Prognostic Stage from the American Joint Committee on Cancer 8th Staging Manual in Luminal B-Like Human Epidermal Growth Factor Receptor 2-Negative Breast Cancer.Cancer management and research · 2022Article
- A simplified breast cancer prognostic score: comparison with the AJCC clinical prognostic staging system.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2021Article
- Relationship between Prognostic Stage in Breast Cancer and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.Journal of clinical medicine · 2021Article
- The prognostic and predictive value of the 8th American Joint Committee on Cancer (AJCC) staging system among early breast cancer patients aged <50 years.Gland surgery · 2021Article
- Prognostic and predictive parameters in breast pathology: a pathologist's primer.Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc · 2021Article
- Evaluation of the 8th edition of the American joint committee on cancer's pathological staging system in prognosis assessment and treatment decision making for stage T1-2N1 breast cancer after mastectomy.Breast (Edinburgh, Scotland) · 2020Article
- Evaluating overall survival and competing risks of survival in patients with early-stage breast cancer using a comprehensive nomogram.Cancer medicine · 2020Article
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13 authors.
Funding
Abstract
purposeAmerican Joint Committee on Cancer (AJCC) staging is used to determine breast cancer prognosis, yet patient survival within each stage shows wide variation. We hypothesized that differences in biology influence this variation and that addition of biologic markers to AJCC staging improves determination of prognosis. PATIENTS AND
methodsWe identified a cohort of 3,728 patients who underwent surgery as the first intervention between 1997 and 2006. A Cox proportional hazards model, with backward stepwise exclusion of factors and stratification on pathologic stage (PS), was used to test the significance of adding grade (G), lymphovascular invasion (L), estrogen receptor (ER) status (E), progesterone receptor (PR) status, combined ER and PR status (EP), or combined ER, PR, and human epidermal growth factor receptor 2 status (M). We assigned values of 0 to 2 to these disease-specific survival (DSS) -associated factors and assessed six different staging systems: PS, PS + G, PS + G L, PS + G E, PS + G EP, and PS + G M. We compared 5-year DSS rates, Akaike's information criterion (AIC), and Harrell's concordance index (C-index) between systems. Surveillance, Epidemiology, and End Results data were used as the external validation cohort (n = 26,711).
resultsMedian follow-up was 6.5 years, and 5-year DSS rate was 97.4%. The PS + G E status staging system was most precise, with a low AIC (1,931.9) and the highest C-index (0.80). PS + G E status was confirmed to stratify outcomes in internal bootstrapping samples and the external validation cohort.
conclusionOur results validate an improved breast cancer staging system that incorporates grade and ER status. We recommend that biologic markers be incorporated into revised versions of the AJCC staging system.
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