Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual

Armando E Giuliano ¹, James L Connolly ², Stephen B Edge ³, Elizabeth A Mittendorf ⁴, Hope S Rugo ⁵, Lawrence J Solin ⁶, Donald L Weaver ⁷, David J Winchester ⁸, Gabriel N Hortobagyi ⁹

Affiliations

¹ Executive Vice Chair, Surgery; Associate Director, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
² Professor of Pathology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
³ Vice President, Healthcare Outcomes and Policy, Roswell Park Cancer Institute, Buffalo, NY.
⁴ Associate Professor, Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
⁵ Professor of Medicine; Director, Breast Oncology and Clinical Trials Education, University of California, San Francisco, San Francisco, CA.
⁶ Chairman, Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, PA.
⁷ Professor of Pathology, University of Vermont, Burlington, VT.
⁸ Associate Director, Kellogg Cancer Surgical Services, NorthShore University HealthSystem, Evanston, IL.
⁹ Professor; Co-Director, Breast Cancer Research Program, The University of Texas MD Anderson Cancer Center, Houston, TX.

PMID: 28294295
153 citations

Abstract

Answer questions and earn CME/CNE The revision of the eighth edition of the primary tumor, lymph node, and metastasis (TNM) classification of the American Joint Commission of Cancer (AJCC) for breast cancer was determined by a multidisciplinary team of breast cancer experts. The panel recognized the need to incorporate biologic factors, such as tumor grade, proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression prognostic panels into the staging system. AJCC levels of evidence and guidelines for all tumor types were followed as much as possible. The panel felt that, to maintain worldwide value, the tumor staging system should remain based on TNM anatomic factors. However, the recognition of the prognostic influence of grade, hormone receptor expression, and HER2 amplification mandated their inclusion into the staging system. The value of commercially available, gene-based assays was acknowledged and prognostic input added. Tumor biomarkers and low Oncotype DX recurrence scores can alter prognosis and stage. These updates are expected to provide additional precision and flexibility to the staging system and were based on the extent of published information and analysis of large, as yet unpublished databases. The eighth edition of the AJCC TNM staging system, thus, provides a flexible platform for prognostic classification based on traditional anatomic factors, which can be modified and enhanced using patient biomarkers and multifactorial prognostic panel data. The eighth edition remains the worldwide basis for breast cancer staging and will incorporate future online updates to remain timely and relevant. CA Cancer J Clin 2017;67:290-303. © 2017 American Cancer Society.

Keywords: biomarkers; distant metastases; ductal carcinoma in situ; estrogen receptor; human epidermal growth receptor 1 (HER2); infiltrating ductal carcinoma; infiltrating lobular carcinoma; lobular carcinoma in situ; lymph node metastases; neoadjuvant chemotherapy.

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Prognostic validation and treatment decision making of the 8th edition of the American Joint Committee on Cancer pathological staging system for elderly women with early-stage breast cancer. San-Gang Wu, Jian Shi, +6 authors, Zhen-Yu He. less Aging (Albany NY), 2020 Jul 28; 12(14). PMID: 32710731 Free PMC article.
Silencing DSCAM-AS1 suppresses the growth and invasion of ER-positive breast cancer cells by downregulating both DCTPP1 and QPRT. Zhang Yue, Jia Shusheng, +5 authors, Huang Yuanxi. less Aging (Albany NY), 2020 Jul 28; 12(14). PMID: 32716908 Free PMC article.
Identification of a Six-lncRNA Signature With Prognostic Value for Breast Cancer Patients. Erjie Zhao, Yujia Lan, +5 authors, Jing Hu. less Front Genet, 2020 Aug 28; 11. PMID: 32849766 Free PMC article.
Phyto-Immunotherapy, a Complementary Therapeutic Option to Decrease Metastasis and Attack Breast Cancer Stem Cells. Susana Fiorentino, Claudia Urueña, +2 authors, Paola Lasso, Karol Prieto, Alfonso Barreto. less Front Oncol, 2020 Aug 28; 10. PMID: 32850424 Free PMC article. Review.
An Intelligent Decision-Making Support System for the Detection and Staging of Prostate Cancer in Developing Countries. Jun Zhang, Zhigang Chen, Jia Wu, Kanghuai Liu. Comput Math Methods Med, 2020 Sep 04; 2020. PMID: 32879636 Free PMC article.
The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation: Methods and overview. Catherine Duggan, Allison Dvaladze, +13 authors, Benjamin O Anderson. less Cancer, 2020 Apr 30; 126 Suppl 10. PMID: 32348573 Free PMC article.
Radiological Society of North America (RSNA) 3D printing Special Interest Group (SIG): guidelines for medical 3D printing and appropriateness for clinical scenarios. Leonid Chepelev, Nicole Wake, +16 authors, RSNA Special Interest Group for 3D Printing. less 3D Print Med, 2019 Jan 17; 4(1). PMID: 30649688 Free PMC article. Highly Cited.
Examination of the Biomark assay as an alternative to Oncotype DX for defining chemotherapy benefit. Jinkyoung Kim, Aeree Kim, Chungyeul Kim. Oncol Lett, 2019 Jan 25; 17(2). PMID: 30675242 Free PMC article.
Ginsenoside Rg3: Potential Molecular Targets and Therapeutic Indication in Metastatic Breast Cancer. Maryam Nakhjavani, Jennifer E Hardingham, +4 authors, Amanda R Townsend. less Medicines (Basel), 2019 Jan 27; 6(1). PMID: 30678106 Free PMC article. Review.
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Estrogen receptor variants in ER-positive basal-type breast cancers responding to therapy like ER-negative breast cancers. Floris H Groenendijk, Tina Treece, +6 authors, Pat Whitworth. less NPJ Breast Cancer, 2019 Apr 25; 5. PMID: 31016233 Free PMC article.
Anatomy is not enough: the crucial role of biology and genetics in AJCC eighth edition of the TNM classification for breast cancer. Francesca Magnoni, Giuseppe Accardo, +2 authors, Elisabetta Rossi, Paolo Veronesi, Giovanni Corso. less Ann Transl Med, 2019 Apr 30; 7(Suppl 1). PMID: 31032313 Free PMC article.
The Effect of the New Eighth Edition Breast Cancer Staging System on 100 Consecutive Patients. Ashley Biswal, Jacqueline Erler, +6 authors, Denise Johnson Miller. less J Clin Med Res, 2019 May 31; 11(6). PMID: 31143307 Free PMC article.
Should a Multigene Signature be Used in all Luminal Early Breast Cancers. Nawale Hajjaji, Yves Marie Robin, Jacques Bonneterre. Front Oncol, 2019 Jun 20; 9. PMID: 31214499 Free PMC article.
High expression of metabolic enzyme PFKFB4 is associated with poor prognosis of operable breast cancer. Ling Yao, Lei Wang, +2 authors, Zhi-Gang Cao, Xin Hu, Zhi-Ming Shao. less Cancer Cell Int, 2019 Jun 28; 19. PMID: 31244553 Free PMC article.
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Cytological Correlates of Axillary Nodal Involvement in Invasive Ductal Carcinoma of Breast. Anamika Sinha, Satyajit Singh Gill. J Cytol, 2019 Jul 31; 36(3). PMID: 31359912 Free PMC article.
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MicroRNA-16 sensitizes drug-resistant breast cancer cells to Adriamycin by targeting Wip1 and Bcl-2. Xitao Gao, Mei Wang, +3 authors, Yanyan Zhang, Zhi Xu, Jiaji Ding, Jinhai Tang. less Oncol Lett, 2019 Aug 28; 18(3). PMID: 31452770 Free PMC article.
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Mechanisms of Resistance to Chemotherapy in Breast Cancer and Possible Targets in Drug Delivery Systems. Patrícia de Faria Lainetti, Antonio Fernando Leis-Filho, +2 authors, Carlos Eduardo Fonseca-Alves. less Pharmaceutics, 2020 Dec 16; 12(12). PMID: 33316872 Free PMC article. Review.
Prognostic and Predictive Value of the American Joint Committee on Cancer Pathological Prognostic Staging System in Nodal Micrometastatic Breast Cancer. Jian Shi, Chen-Lu Lian, +6 authors, San-Gang Wu. less Front Oncol, 2021 Jan 05; 10. PMID: 33392071 Free PMC article.
Predictive Value of CD44 for Prognosis in Patients with Breast Cancer. Yousef Roosta, Zohreh Sanaat, +2 authors, Ali Reza Nikanfar, Roya Dolatkhah, Ashraf Fakhrjou. less Asian Pac J Cancer Prev, 2020 Sep 29; 21(9). PMID: 32986353 Free PMC article.
Factors That Predict Biological Aggressiveness in Estrogen Receptor-Positive / Human Epidermal Growth Factor Receptor 2-Negative / Lymph Node-Negative Breast Cancer. Lauren E Arthur, Ashley H McMann, +4 authors, Ralph L Corsetti. less Ochsner J, 2021 Jan 08; 20(4). PMID: 33408575 Free PMC article.
Chip-Scale Angle-Selective Imager for In Vivo Microscopic Cancer Detection. Efthymios P Papageorgiou, Bernhard E Boser, Mekhail Anwar. IEEE Trans Biomed Circuits Syst, 2019 Dec 14; 14(1). PMID: 31831434 Free PMC article.
A Novel Staging System for De Novo Metastatic Breast Cancer Refines Prognostic Estimates. Jennifer K Plichta, Samantha M Thomas, +7 authors, E Shelley Hwang. less Ann Surg, 2020 Jul 14;. PMID: 32657941 Free PMC article.
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SOX12 expression is associated with progression and poor prognosis in human breast cancer. Junming Xu, Jinyan Zhang, +3 authors, Lei Li, Jieqi Mao, Tiangeng You, Yang Li. less Am J Transl Res, 2021 Jan 14; 12(12). PMID: 33437389 Free PMC article.
Staging for Breast Cancer With Internal Mammary Lymph Nodes Metastasis: Utility of Incorporating Biologic Factors. Chen-Lu Lian, Hai-Yan Zhang, +4 authors, San-Gang Wu. less Front Oncol, 2021 Feb 02; 10. PMID: 33520700 Free PMC article.
Combined analysis of miR-200 family and its significance for breast cancer. Andrea Fontana, Raffaela Barbano, +16 authors, Paola Parrella. less Sci Rep, 2021 Feb 05; 11(1). PMID: 33536459 Free PMC article.
Concordance between results of inexpensive statistical models and multigene signatures in patients with ER+/HER2- early breast cancer. Laurence Slembrouck, Isabelle Vanden Bempt, +12 authors, Giuseppe Floris. less Mod Pathol, 2021 Feb 10;. PMID: 33558657
Targeting the purinergic pathway in breast cancer and its therapeutic applications. Julia Beatrice de Araújo, Vanessa Vitória Kerkhoff, Sarah Franco Vieira de Oliveira Maciel, Débora Tavares de Resende E Silva. Purinergic Signal, 2021 Feb 13;. PMID: 33576905 Free PMC article. Review.

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