新分期对三阴性乳腺癌的预测价值

　　国际抗癌联盟（UICC）和美国癌症联合委员会（AJCC）分期系统第8版由解剖分期转变为预后分期，于2018年1月1日在全球正式启用。不过，该预后分期系统对于三阴性乳腺癌患者生存结局的预测作用尚不明确。

　　2019年1月8日，英国未来医学旗下《未来肿瘤学》在线发表复旦大学附属肿瘤医院刘莹莹、余天剑、柳光宇等学者的大数据研究报告，根据预后分期系统分析了三阴性乳腺癌患者的分期变化和生存差异。

　　该大数据研究利用美国国家癌症研究所（NCI）监测流行病学结果（SEER）数据库对2010～2014年1万9608例三阴性乳腺癌患者进行回顾分析，通过绘制生存曲线进行比较，主要研究终点为乳腺癌相关生存。

　　结果，1万9608例患者的中位随访时间为26个月（四分位12～41个月），乳腺癌相关死亡患者1745例（8.9%）。将解剖分期该为预后分期，所有三阴性乳腺癌患者的分期提高或维持不变。大多数患者分期为IIA、IIIA、IIIC期，少数患者无法进行预后分期。IIIC期包括6种差异较大的亚分期：

• T2 N1 G3

• T3 N0 G3

• T0-2 N2 G2-3

• T3 N1-2 G2-3

• T4 N0-2 G1-3

• T0-4 N3 G1-3

　　总体而言，生存曲线表明分期和亚分期对于患者的生存结局具有预测作用，除了IIB期和IIIA期（T2 N0 G2-3）患者。

　　因此，根据该独立分析结果，新的预后分期系统对于三阴性乳腺癌患者的预后有待改进，对于IIB期和IIIA期（T2 N0 G2-3）应该进行进一步评估。

Future Oncol. 2019 Jan 8. [Epub ahead of print]

The predictive value of the prognostic staging system in the 8th edition of the American Joint Committee on Cancer for triple-negative breast cancer: a SEER population-based analysis.

Liu YY, Yu TJ, Liu GY.

Fudan University Shanghai Cancer Center, Shanghai, China; Shanghai Medical College, Fudan University, Shanghai, China.

AIM: To examine the stage changes and survival differences among triple-negative breast cancer (TNBC) patients based on the prognostic staging system.

METHODS: We used the SEER database to identify eligible patients with TNBC diagnosed between 2010 and 2014. Kaplan-Meier curves were drawn for comparison. The primary end point was breast cancer-specific survival.

RESULTS: The median follow-up time was 26 months for 19,608 patients. The stages of all TNBC patients increased or remained unchanged during rearrangement from anatomic staging to prognostic staging. Stage IIA, IIIA and IIIC comprised the majority of patients. Several patients did not have prognostic staging. Stage IIIC incorporated six substages that contributed to high heterogeneity. Overall, the Kaplan-Meier curves still showed the favorable differentiation among stages and substages, with the exception of stage IIB and substage IIIA (T2N0, grade 2-3) patients.

CONCLUSION: The prognostic information for breast cancer patients provided by the novel prognostic staging system may be less accurate for TNBC patients in our independent analysis. Moreover, stage IIB and substage IIIA (T2N0, grade 2-3) should possibly undergo further evaluation.

KEYWORDS: 8th AJCC; SEER; TNM stage; anatomic staging system; breast cancer-specific survival; prognosis; prognostic staging system; triple-negative breast cancer

PMID: 30620221

DOI: 10.2217/fon-2018-0145

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