American Joint Committee on Cancer Tumor–Node–Metastasis Stage After Neoadjuvant Chemotherapy and Breast Cancer Outcome

Background: Response to neoadjuvant chemotherapy is used as an intermediate endpoint for breast cancer relapse and survival. Most breast cancer response classification systems use pathologic complete response, either alone or in conjunction with clinical assessments, to categorize response. We exami...

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Bibliographic Details
Published in:JNCI : Journal of the National Cancer Institute 2005-08, Vol.97 (15), p.1137-1142
Main Authors: Carey, Lisa A., Metzger, Richard, Dees, E. Claire, Collichio, Frances, Sartor, Carolyn I., Ollila, David W., Klauber-DeMore, Nancy, Halle, Jan, Sawyer, Lynda, Moore, Dominic T., Graham, Mark L.
Format: Article
Language:English
Subjects:
Adult
Aged
Antineoplastic agents
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Biological and medical sciences
Breast cancer
Breast Neoplasms - classification
Breast Neoplasms - drug therapy
Breast Neoplasms - pathology
Chemotherapy
Chemotherapy, Adjuvant
Classification
Clinical outcomes
Disease-Free Survival
Female
Humans
Lymph Node Excision
Lymph Nodes - pathology
Lymphatic Metastasis
Mastectomy - methods
Medical sciences
Middle Aged
Neoadjuvant Therapy - methods
Neoplasm Staging - methods
Neoplasm, Residual
Pharmacology. Drug treatments
Prognosis
Proportional Hazards Models
Survival Analysis
Tumors
United States
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Summary:Background: Response to neoadjuvant chemotherapy is used as an intermediate endpoint for breast cancer relapse and survival. Most breast cancer response classification systems use pathologic complete response, either alone or in conjunction with clinical assessments, to categorize response. We examined the ability of the revised 2003 American Joint Committee on Cancer (AJCC) tumor–node–metastasis (TNM) staging system, which considers both the number of involved axillary lymph nodes and the extent of tumor in the breast to predict patient survival after neoadjuvant chemotherapy for breast cancer. Methods: We assessed the pathologic stage of residual tumor in 132 patients with nonmetastatic breast cancer after they had undergone neoadjuvant chemotherapy and examined the association between AJCC TNM stage and subsequent distant disease–free survival and overall survival. All statistical tests were two-sided. Results: At a median follow-up of 5 years, pathologic stage in the surgical specimens after neoadjuvant chemotherapy using the revised AJCC system was strongly associated with both distant disease–free survival and overall survival. A higher pathologic stage of residual tumor after neoadjuvant chemotherapy was associated with a statistically significant lower rate of distant disease–free survival (stage 0: 95%, stage I: 84%, stage II: 72%, and stage III: 47%; Ptrend
ISSN:0027-8874
1460-2105
DOI:10.1093/jnci/dji206