0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Personalizing Breast Cancer Staging by the Inclusion of ER, PR, and HER2

Sanjay P. Bagaria, MD1; Partha S. Ray, MD2,3; Myung-Shin Sim, MS, DrPH4; Xing Ye, MS4; Jaime M. Shamonki, MD5; Xiaojiang Cui, PhD6; Armando E. Giuliano, MD7
[+] Author Affiliations
1Department of Surgery, Mayo Clinic Florida, Jacksonville
2Department of Surgery, University of Illinois Urbana-Champaign
3Carle Cancer Center, Urbana-Champaign, Illinois
4Department of Biostatistics, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California
5Department of Pathology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, California
6Department of Molecular Oncology, Cedars-Sinai Medical Center, West Hollywood, California
7Department of Surgery, Cedars-Sinai Medical Center, West Hollywood, California
JAMA Surg. 2014;149(2):125-129. doi:10.1001/jamasurg.2013.3181.
Text Size: A A A
Published online

Importance  Nonanatomic factors, such as histologic grade and biomarkers, can guide breast cancer management but are not included in the current TNM staging system.

Objective  To use as an example the triple-negative phenotype (TNP) defined by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) to examine whether such inclusion improves the prognostic accuracy of TNM staging for breast cancer.

Design, Setting, and Participants  Women diagnosed with primary invasive ductal breast cancer from January 1, 1991, through December 31, 2008, were identified from a prospective institutional database. Excluded were patients who received neoadjuvant therapy, those whose staging information was incomplete, or those whose tumor lacked ER, PR, and HER2 data. Breast cancers were categorized by TNM stage and by the presence or absence of TNP.

Main Outcomes and Measures  Overall survival at 5 years.

Results  Database review identified 1842 consecutive eligible patients with breast cancer. When patients were stratified by TNM stage, overall survival curves for those with TNP breast cancer matched those for patients whose non-TNP breast cancer was 1 TNM stage higher. Multivariable analysis showed that TNP status was a powerful prognostic variable, and the likelihood ratio test revealed that the prognostic accuracy of the TNM staging system that incorporated TNP was superior to the current TNM staging system (P < .001). A TNM staging system that incorporated TNP reduced early-stage compression by 15%.

Conclusions and Relevance  The internationally recognized and easily reproducible examination of ER, PR, and HER2 status exemplifies how nonanatomic factors can improve the prognostic accuracy of breast cancer staging.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure 1.
Study Flow

TNP indicates triple-negative phenotype.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Survival Curves of 1842 Consecutive Patients With Breast Cancer Stratified by Stage and TNP Status

The survival curves for patients with triple-negative phenotype (TNP) overlapped with the survival curves for patients with non-TNP of the next higher stage.

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();