Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting
Abstract
:1. Introduction
2. Materials and Methods
3. Results
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Value |
---|---|
Age, in years | |
Median (interquartile range) | 54 (46–63) |
Center, n (%) | |
University Malaya Medical Center (UMMC) | 1304 (31.4) |
University Malaya Surgical Center (UMSC) | 360 (8.7) |
Sime Darby Medical Center (SJMC) | 2487 (59.9) |
Missing | 0 |
Ethnicity, n (%) | |
Chinese | 3249 (78.3) |
Malay | 509 (12.3) |
Indian | 379 (9.1) |
Others | 14 (0.3) |
Missing | 0 |
Tumor size (in cm) | |
Median (interquartile range) | 2.1 (1.5–3.0) |
Number of positive lymph nodes | |
Median (interquartile range) | 0 (0–2) |
Type of surgery, n (%) | |
Mastectomy | 2743 (66.1) |
Breast conserving surgery | 1403 (33.8) |
Missing | 4 (0.1) |
Chemotherapy, n (%) | |
Yes | 2067 (49.8) |
No | 1752 (42.2) |
Missing | 331 (8.0) |
Radiotherapy, n (%) | |
Yes | 2215 (53.4) |
No | 1628 (39.2) |
Missing | 308 (7.4) |
Hormone therapy, n (%) | |
Yes | 2674 (64.4) |
No | 1154 (27.8) |
Missing | 323 (7.8) |
Targeted therapy, n (%) | |
Yes | 274 (6.6) |
No | 3877 (93.4) |
Missing | 0 |
AJCC7 | AJCC8 | ||||||||
---|---|---|---|---|---|---|---|---|---|
IA | IB | IIA | IIB | IIIA | IIIB | IIIC | Missing | Total | |
IA | 1333 (87.4) | 153 (10.0) | 39 (2.6) | 1525 | |||||
IB | 4 (80.0) | 1 (20.0) | 0 | 5 | |||||
IIA | 592 (45.3) | 150 (11.5) | 499 (38.2) | 66 (5.0) | 1307 | ||||
IIB | 32 (6.3) | 204 (40.0) | 55 (10.8) | 137 (26.9) | 52 (10.2) | 30 (5.9) | 510 | ||
IIIA | 150 (39.4) | 14 (3.7) | 40 (10.5) | 108 (28.3) | 13 (3.4) | 32 (8.4) | 24 (6.3) | 381 | |
IIIB | 40 (28.2) | 54 (38.0) | 39 (27.5) | 9 (6.3) | 142 | ||||
IIIC | 80 (28.5) | 133 (47.3) | 44 (15.7) | 24 (8.5) | 281 | ||||
Total | 1961 | 658 | 568 | 177 | 280 | 200 | 115 | 192 | 4151 |
AJCC7 | AJCC8 | Number of Patients | Number of Deaths | Survival Probability (95% CI) |
---|---|---|---|---|
IA | IA | 1333 | 34 | 0.97 (0.87–1.00) |
IB | 153 | 9 | 0.93 (0.89–0.98) | |
IB | IA | 4 | 0 | - |
IB | 1 | 0 | - | |
IIA | IA | 592 | 25 | 0.95 (0.92–0.97) |
IB | 150 | 4 | 0.96 (0.93–1.00) | |
IIA | 499 | 50 | 0.89 (0.86–0.92) | |
IIB | IA | 32 | 1 | 0.97 (0.91–1.00) |
IB | 204 | 12 | 0.92 (0.87–0.97) | |
IIA | 55 | 7 | 0.85 (0.75–0.95) | |
IIB | 137 | 19 | 0.85 (0.79–0.91) | |
IIIA | 52 | 9 | 0.81 (0.69–0.92) | |
IIIA | IB | 150 | 7 | 0.95 (0.91–0.99) |
IIA | 14 | 0 | - | |
IIB | 40 | 3 | 0.895 (0.77–1.00) | |
IIIA | 108 | 20 | 0.794 (0.71–0.88) | |
IIIB | 13 | 0 | - | |
IIIC | 32 | 6 | 0.788 (0.64–0.94) | |
IIIB | IIIA | 40 | 4 | 0.891 (0.79–0.99) |
IIIB | 54 | 18 | 0.644 (0.51–0.78) | |
IIIC | 39 | 18 | 0.448 (0.27–0.63) | |
IIIC | IIIA | 80 | 12 | 0.809 (0.71–0.91) |
IIIB | 133 | 45 | 0.611 (0.52–0.70) | |
IIIC | 44 | 17 | 0.581 (0.43–0.74) |
AJCC7 | AJCC8 | |||||||
---|---|---|---|---|---|---|---|---|
Univariate | Multivariate | Univariate | Multivariate | |||||
AJCC-Only Model | Hazard Ratio | p-Value | Hazard Ratio | p-Value | Hazard Ratio | p-Value | Hazard Ratio | p-Value |
Stage | ||||||||
IA | 1 | 1 | 1 | 1 | ||||
IB | * | * | 1.65 (1.07–2.53) | 0.02 | 2.10 (1.31–3.36) | <0.01 | ||
IIA | 2.26 (1.56–3.28) | <0.01 | 2.04 (1.36–3.07) | <0.01 | 3.33 (2.32–4.78) | <0.01 | 2.97 (1.92–4.60) | <0.01 |
IIB | 3.61 (2.39–5.45) | <0.01 | 4.63 (2.93–7.32) | <0.01 | 4.23 (2.60–6.90) | <0.01 | 5.94 (3.40–10.38) | <0.01 |
IIIA | 3.68 (2.36–5.73) | <0.01 | 4.89 (2.95–8.09) | <0.01 | 5.75 (3.91–8.47) | <0.01 | 7.83 (4.93–12.43) | <0.01 |
IIIB | 12.62 (8.20–19.41) | <0.01 | 13.74 (8.39–22.51) | <0.01 | 12.03 (8.44–17.13) | <0.01 | 14.91 (9.56–23.24) | <0.01 |
IIIC | 11.97 (8.22–17.44) | <0.01 | 14.93 (9.59–23.23) | <0.01 | 14.43 (9.70–21.48) | <0.01 | 14.07 (8.39–23.60) | <0.01 |
Age (per 1-year increase) | 1.02 (1.00–1.03) | <0.01 | 1.01 (1.00–1.02) | 0.05 | ||||
Ethnicity | ||||||||
Chinese | 1 | 1 | ||||||
Malay | 1.29 (0.92–1.82) | 0.14 | 1.32 (0.94–1.86) | 0.11 | ||||
Indian | 0.82 (0.54–1.23) | 0.33 | 0.89 (0.59–1.35) | 0.59 | ||||
Other | 1.67 (0.23–12.03) | 0.61 | 1.87 (0.26–13.49) | 0.53 | ||||
Center | ||||||||
UMMC | 1 | 1 | ||||||
UMSC | 0.75 (0.47–1.19) | 0.22 | 0.69 (0.43–1.11) | 0.13 | ||||
SDMC | 0.52 (0.38–0.69) | <0.01 | 0.53 (0.40–0.71) | <0.01 | ||||
Type of surgery | ||||||||
Mastectomy | 1 | 1 | ||||||
Breast conserving surgery | 0.96 (0.68–1.35) | 0.82 | 0.90 (0.64–1.28) | 0.57 | ||||
Adjuvant treatment (compared to not receiving the corresponding adjuvant treatment) | ||||||||
Chemotherapy | 0.59 (0.44–0.80) | <0.01 | 0.54 (0.40–0.73) | <0.01 | ||||
Radiotherapy | 0.64 (0.47–0.89) | <0.01 | 0.64 (0.46–0.88) | <0.01 | ||||
Hormone therapy | 0.34 (0.27–0.44) | <0.01 | 0.55 (0.41–0.72) | <0.01 | ||||
Targeted therapy | 0.39 (0.19–0.80) | <0.01 | 0.40 (0.19–0.83) | 0.01 | ||||
Concordance | 0.720 (0.694–0.747) | 0.799 (0.777–0.829) | 0.745 (0.716–0.774) | 0.795 (0.773–0.825) |
AJCC7 | AJCC8 | |||||||
---|---|---|---|---|---|---|---|---|
AJCC-Only Model | Hazard Ratio | p-Value | Hazard Ratio | p-Value | Hazard Ratio | p-Value | Hazard Ratio | p-Value |
Stage | ||||||||
IA | 1 | 1 | 1 | 1 | ||||
IB | * | * | 1.79 (1.17–2.75) | <0.01 | 2.09 (1.31–3.34) | <0.01 | ||
IIA | 2.13 (1.47–3.09) | <0.01 | 2.05 (1.37–3.09) | <0.01 | 3.37 (2.35–4.84) | <0.01 | 2.94 (1.90–4.55) | <0.01 |
IIB | 3.74 (2.47–5.66) | <0.01 | 4.61 (2.90–7.31) | <0.01 | 3.85 (2.34–6.33) | <0.01 | 5.64 (3.20–9.94) | <0.01 |
IIIA | 3.64 (2.34–5.67) | <0.01 | 5.22 (3.15–8.63) | <0.01 | 5.83 (3.94–8.63) | <0.01 | 7.75 (4.85–12.37) | <0.01 |
IIIB | 8.40 (5.43–13.01) | <0.01 | 13.47 (8.15–22.25) | <0.01 | 11.40 (7.99–16.27) | <0.01 | 14.60 (9.37–22.77) | <0.01 |
IIIC | 13.52 (9.28–19.71) | <0.01 | 15.36 (9.90–23.85) | <0.01 | 11.97 (8.04–17.82) | <0.01 | 14.98 (8.92–25.15) | <0.01 |
Age (per 1-year increase) | 0.92 (0.91–0.93) | <0.01 | 0.92 (0.91–0.93) | <0.01 | ||||
Ethnicity | ||||||||
Chinese | 1 | 1 | ||||||
Malay | 1.21 (0.86–1.70) | 0.27 | 1.25 (0.89–1.76) | 0.19 | ||||
Indian | 0.65 (0.43–0.98) | 0.04 | 0.71 (0.47–1.08) | 0.11 | ||||
Other | 1.41 (1.19–10.13) | 0.74 | 1.57 (0.22–11.33) | 0.65 | ||||
Center | ||||||||
UMMC | 1 | 1 | ||||||
UMSC | 0.62 (0.38–0.99) | 0.04 | 0.57 (0.36–0.92) | 0.02 | ||||
SDMC | 0.63 (0.47–0.83) | <0.01 | 0.64 (0.48–0.86) | <0.01 | ||||
Type of surgery | ||||||||
Mastectomy | 1 | 1 | ||||||
Breast-conserving surgery | 1.00 (0.71–1.41) | 0.99 | 0.93 (0.66–1.32) | 0.69 | ||||
Adjuvant treatment (compared to not receiving the corresponding adjuvant treatment) | ||||||||
Chemotherapy | 0.62 (0.45–0.84) | <0.01 | 0.56 (0.41–0.76) | <0.01 | ||||
Radiotherapy | 0.60 (0.43–0.84) | <0.01 | 0.60 (0.43–0.83) | <0.01 | ||||
Hormone therapy | 0.34 (0.27–0.44) | <0.01 | 0.55 (0.41–0.72) | <0.01 | ||||
Targeted therapy | 0.33 (0.15–0.72) | <0.01 | 0.35 (0.16–0.76) | <0.01 | ||||
Concordance | 0.692 (0.658–0.728) | 0.792 (0.769–0.825) | 0.710 (0.674–0.748) | 0.788 (0.764–0.820) |
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Song, C.-V.; van Gils, C.H.; Yip, C.-H.; Soerjomataram, I.; Taib, N.A.M.; See, M.-H.; Lim, A.; Abdul Satar, N.F.; Bhoo-Pathy, N. Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting. Diagnostics 2023, 13, 674. https://doi.org/10.3390/diagnostics13040674
Song C-V, van Gils CH, Yip C-H, Soerjomataram I, Taib NAM, See M-H, Lim A, Abdul Satar NF, Bhoo-Pathy N. Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting. Diagnostics. 2023; 13(4):674. https://doi.org/10.3390/diagnostics13040674
Chicago/Turabian StyleSong, Chin-Vern, Carla H. van Gils, Cheng-Har Yip, Isabelle Soerjomataram, Nur Aishah Mohd Taib, Mee-Hoong See, Alexander Lim, Nur Fadhlina Abdul Satar, and Nirmala Bhoo-Pathy. 2023. "Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting" Diagnostics 13, no. 4: 674. https://doi.org/10.3390/diagnostics13040674