Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer

Elizabeth A. Mittendorf, Karla V. Ballman, Linda M. McCall, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, Nora Hansen, Sheryl Gabram, Thelma C Hurd, Armando E. Giuliano, Kelly K. Hunt

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer differentiates patients with T1 tumors and lymph node micrometastases (stage IB) from patients with T1 tumors and negative nodes (stage IA). This study was undertaken to determine the utility of the stage IB designation. Patients and Methods The following two cohorts of patients with breast cancer were identified: 3,474 patients treated at The University of TexasMDAnderson Cancer Center from 1993 to 2007 and 4,590 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0010 trial. Clinicopathologic and outcomes data were recorded, and disease was staged according to the seventh edition AJCC staging system. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were determined using the Kaplan-Meier method and compared using the log-rank test. Results Median follow-up times were 6.1 years and 9.0 years for the MD Anderson Cancer Center and ACOSOG cohorts, respectively. In both cohorts, there were no significant differences between patients with stage IA and stage IB disease in 5- or 10-year RFS, DSS, or OS. Estrogen receptor (ER) status and grade significantly stratified patients with stage I disease with respect to RFS, DSS, and OS. Conclusion Among patients with T1 breast cancer, individuals with micrometastases and those with negative nodes have similar survival outcomes. ER status and grade are better discriminants of survival than the presence of small-volume nodal metastases. In preparing the next edition of the AJCC staging system, consideration should be given to eliminating the stage IB designation and incorporating biologic factors.

Original languageEnglish (US)
Pages (from-to)1119-1127
Number of pages9
JournalJournal of Clinical Oncology
Volume33
Issue number10
DOIs
StatePublished - Apr 1 2015
Externally publishedYes

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Neoplasm Staging
Breast Neoplasms
Survival
Disease-Free Survival
Neoplasm Micrometastasis
Recurrence
Estrogen Receptors
Neoplasms
Biological Factors
Lymph Nodes
Neoplasm Metastasis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mittendorf, E. A., Ballman, K. V., McCall, L. M., Yi, M., Sahin, A. A., Bedrosian, I., ... Hunt, K. K. (2015). Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer. Journal of Clinical Oncology, 33(10), 1119-1127. https://doi.org/10.1200/JCO.2014.57.2958

Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer. / Mittendorf, Elizabeth A.; Ballman, Karla V.; McCall, Linda M.; Yi, Min; Sahin, Aysegul A.; Bedrosian, Isabelle; Hansen, Nora; Gabram, Sheryl; Hurd, Thelma C; Giuliano, Armando E.; Hunt, Kelly K.

In: Journal of Clinical Oncology, Vol. 33, No. 10, 01.04.2015, p. 1119-1127.

Research output: Contribution to journalArticle

Mittendorf, EA, Ballman, KV, McCall, LM, Yi, M, Sahin, AA, Bedrosian, I, Hansen, N, Gabram, S, Hurd, TC, Giuliano, AE & Hunt, KK 2015, 'Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer', Journal of Clinical Oncology, vol. 33, no. 10, pp. 1119-1127. https://doi.org/10.1200/JCO.2014.57.2958
Mittendorf, Elizabeth A. ; Ballman, Karla V. ; McCall, Linda M. ; Yi, Min ; Sahin, Aysegul A. ; Bedrosian, Isabelle ; Hansen, Nora ; Gabram, Sheryl ; Hurd, Thelma C ; Giuliano, Armando E. ; Hunt, Kelly K. / Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 10. pp. 1119-1127.
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abstract = "Purpose The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer differentiates patients with T1 tumors and lymph node micrometastases (stage IB) from patients with T1 tumors and negative nodes (stage IA). This study was undertaken to determine the utility of the stage IB designation. Patients and Methods The following two cohorts of patients with breast cancer were identified: 3,474 patients treated at The University of TexasMDAnderson Cancer Center from 1993 to 2007 and 4,590 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0010 trial. Clinicopathologic and outcomes data were recorded, and disease was staged according to the seventh edition AJCC staging system. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were determined using the Kaplan-Meier method and compared using the log-rank test. Results Median follow-up times were 6.1 years and 9.0 years for the MD Anderson Cancer Center and ACOSOG cohorts, respectively. In both cohorts, there were no significant differences between patients with stage IA and stage IB disease in 5- or 10-year RFS, DSS, or OS. Estrogen receptor (ER) status and grade significantly stratified patients with stage I disease with respect to RFS, DSS, and OS. Conclusion Among patients with T1 breast cancer, individuals with micrometastases and those with negative nodes have similar survival outcomes. ER status and grade are better discriminants of survival than the presence of small-volume nodal metastases. In preparing the next edition of the AJCC staging system, consideration should be given to eliminating the stage IB designation and incorporating biologic factors.",
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AU - Sahin, Aysegul A.

AU - Bedrosian, Isabelle

AU - Hansen, Nora

AU - Gabram, Sheryl

AU - Hurd, Thelma C

AU - Giuliano, Armando E.

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