BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC) staging has introduced prognostic stage based on anatomic stage combined with biologic factors. We aimed to validate the prognostic stage in HER2-positive breast cancer patients enrolled in the ShortHER trial. METHODS: The ShortHER trial randomized 1253 HER2-positive patients to 9 weeks or 1 year of adjuvant trastuzumab combined with chemotherapy. Patients were classified according to the anatomic and the prognostic stage. Distant disease-free survival (DDFS) was calculated from randomization to distant relapse or death. RESULTS: A total of 1244 patients were included. Compared to anatomic stage, the prognostic stage downstaged 41.6% (n = 517) of patients to a more favorable stage category. Five-year DDFS based on anatomic stage was as follows: IA 96.6%, IB 94.1%, IIA 92.4%, IIB 87.3%, IIIA 81.3%, IIIC 70.5% (P < 0.001). Five-year DDFS according to prognostic stage was as follows: IA 95.7%, IB 91.4%, IIA 86.9%, IIB 85.0%, IIIA 77.6%, IIIC 67.7% (P < 0.001). The C index was similar (0.69209 and 0.69249, P = 0.975). Within anatomic stage I, the outcome was similar for patients treated with 9 weeks or 1 year trastuzumab (5-year DDFS 96.2% and 96.6%, P = 0.856). Within prognostic stage I, the outcome was numerically worse for patients treated with 9 weeks trastuzumab (5-year DDFS 93.7% and 96.3%, P = 0.080). CONCLUSIONS: The prognostic stage downstaged 41.6% of patients, while maintaining a similar prognostic performance as the anatomic stage. The prognostic stage is valuable in counseling patients and may serve as reference for a clinical trial design. Our data do not support prognostic stage as guidance to de-escalate treatment.

Validation of the AJCC prognostic stage for HER2-positive breast cancer in the ShortHER trial / Dieci, Mv; Bisagni, G; Brandes, Aa; Frassoldati, A; Cavanna, L; Giotta, F; Aieta, M; Gebbia, V; Musolino, A; Garrone, O; Donadio, M; Rimanti, A; Beano, A; Zamagni, C; Soto Parra, H; Piacentini, F; Danese, S; Ferro, A; Cagossi, K; Sarti, S; Gambaro, Ar; Romito, S; Bazan, V; Amaducci, L; Moretti, G; Foschini, Mp; Balduzzi, S; Vicini, R; D'Amico, R; Griguolo, G; Guarneri, V; Conte, Pf.. - In: BMC MEDICINE. - ISSN 1741-7015. - 17:(1):207(2019), pp. 1-1. [10.1186/s12916-019-1445-z]

Validation of the AJCC prognostic stage for HER2-positive breast cancer in the ShortHER trial .

Dieci MV;Piacentini F;Balduzzi S;Vicini R;D'Amico R;Guarneri V;Conte PF.
2019

Abstract

BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC) staging has introduced prognostic stage based on anatomic stage combined with biologic factors. We aimed to validate the prognostic stage in HER2-positive breast cancer patients enrolled in the ShortHER trial. METHODS: The ShortHER trial randomized 1253 HER2-positive patients to 9 weeks or 1 year of adjuvant trastuzumab combined with chemotherapy. Patients were classified according to the anatomic and the prognostic stage. Distant disease-free survival (DDFS) was calculated from randomization to distant relapse or death. RESULTS: A total of 1244 patients were included. Compared to anatomic stage, the prognostic stage downstaged 41.6% (n = 517) of patients to a more favorable stage category. Five-year DDFS based on anatomic stage was as follows: IA 96.6%, IB 94.1%, IIA 92.4%, IIB 87.3%, IIIA 81.3%, IIIC 70.5% (P < 0.001). Five-year DDFS according to prognostic stage was as follows: IA 95.7%, IB 91.4%, IIA 86.9%, IIB 85.0%, IIIA 77.6%, IIIC 67.7% (P < 0.001). The C index was similar (0.69209 and 0.69249, P = 0.975). Within anatomic stage I, the outcome was similar for patients treated with 9 weeks or 1 year trastuzumab (5-year DDFS 96.2% and 96.6%, P = 0.856). Within prognostic stage I, the outcome was numerically worse for patients treated with 9 weeks trastuzumab (5-year DDFS 93.7% and 96.3%, P = 0.080). CONCLUSIONS: The prognostic stage downstaged 41.6% of patients, while maintaining a similar prognostic performance as the anatomic stage. The prognostic stage is valuable in counseling patients and may serve as reference for a clinical trial design. Our data do not support prognostic stage as guidance to de-escalate treatment.
2019
21-nov-2019
17
(1):207
1
1
Validation of the AJCC prognostic stage for HER2-positive breast cancer in the ShortHER trial / Dieci, Mv; Bisagni, G; Brandes, Aa; Frassoldati, A; Cavanna, L; Giotta, F; Aieta, M; Gebbia, V; Musolino, A; Garrone, O; Donadio, M; Rimanti, A; Beano, A; Zamagni, C; Soto Parra, H; Piacentini, F; Danese, S; Ferro, A; Cagossi, K; Sarti, S; Gambaro, Ar; Romito, S; Bazan, V; Amaducci, L; Moretti, G; Foschini, Mp; Balduzzi, S; Vicini, R; D'Amico, R; Griguolo, G; Guarneri, V; Conte, Pf.. - In: BMC MEDICINE. - ISSN 1741-7015. - 17:(1):207(2019), pp. 1-1. [10.1186/s12916-019-1445-z]
Dieci, Mv; Bisagni, G; Brandes, Aa; Frassoldati, A; Cavanna, L; Giotta, F; Aieta, M; Gebbia, V; Musolino, A; Garrone, O; Donadio, M; Rimanti, A; Beano...espandi
File in questo prodotto:
File Dimensione Formato  
paper AJCC ShortHER.pdf

Open access

Descrizione: Articolo principale
Tipologia: Versione pubblicata dall'editore
Dimensione 824.35 kB
Formato Adobe PDF
824.35 kB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

Licenza Creative Commons
I metadati presenti in IRIS UNIMORE sono rilasciati con licenza Creative Commons CC0 1.0 Universal, mentre i file delle pubblicazioni sono rilasciati con licenza Attribuzione 4.0 Internazionale (CC BY 4.0), salvo diversa indicazione.
In caso di violazione di copyright, contattare Supporto Iris

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1184708
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 4
  • ???jsp.display-item.citation.isi??? 4
social impact