Background/Objectives:The 8th edition of the American Joint Committee on Cancer integrates histology and biomarker status with anatomic extent in breast cancer (BC) pathologic prognostic staging (PPS). However, PPS IB includes anatomic locally advanced hormone-receptor-positive/HER2-negative (LA-HR+/HER2-) and early-stage triple-negative BC (ES-TNBC). Previous research shows that increased nodal involvement is a critical predictor of worse prognosis, raising questions about whether biological subtype or anatomic stage has a greater influence on outcomes in these discordant cases. We hypothesized that overall survival (OS) remains worse for LA-HR+/HER2- BC compared to ES-TNBC, despite both being classified as PPS IB.Methods:Using the National Cancer Database, we identified patients with LA-HR+/HER2- BC (pT3N1 or pT1-3N2, grade 1–2) and ES-TNBC (T1N0, grade 2–3) treated between 2004 and 2017. Patients without complete primary tumor stage, biomarker status, grade, TNM staging, or treated with neoadjuvant therapy were excluded. The primary endpoint was OS. Multivariable Cox regression evaluated OS between LA-HR+/HER2- BC and ES-TNBC.Results:Among 45,818 patients (17,359 LA-HR+/HER2- BC and 28,459 ES-TNBC), LA-HR+/HER2- BC had significantly worse 6-year OS (86.1% vs. 90.4%; HR = 1.63;p< 0.0001). Among patients receiving appropriate therapies, patients with LA-HR+/HER2- BC had 35% relatively higher risk of death (HR = 1.35; 1.24–1.48;p< 0.0001). These results highlight that LA-HR+/HER2- breast cancer has worse survival compared to ES-TNBC, despite both being classified as PPS IB and receiving all appropriate treatments.Conclusions:Anatomic disease extent remains an important factor in patients with discordant AS and PPS. Future iterations of PPS should re-classify LA-HR+/HER2- breast cancer from PPS IB to ensure more accurate prognostic and survival information.
背景/目的：美国癌症联合委员会第八版分期系统将组织学与生物标志物状态整合至乳腺癌病理预后分期中。然而，该分期中的IB期同时纳入了局部晚期激素受体阳性/HER2阴性乳腺癌与早期三阴性乳腺癌。既往研究表明，淋巴结受累增加是预后不良的关键预测因素，这引发了关于在这些不一致病例中生物学亚型或解剖学分期对预后影响更大的疑问。我们假设，尽管两者均被归类为病理预后分期IB期，局部晚期激素受体阳性/HER2阴性乳腺癌的总生存期仍较早期三阴性乳腺癌更差。 方法：通过美国国家癌症数据库，我们筛选了2004年至2017年间接受治疗的局部晚期激素受体阳性/HER2阴性乳腺癌（pT3N1或pT1-3N2，分级1-2级）与早期三阴性乳腺癌（T1N0，分级2-3级）患者。排除原发肿瘤分期、生物标志物状态、分级、TNM分期信息不全或接受新辅助治疗的患者。主要终点为总生存期。采用多变量Cox回归分析比较两类乳腺癌的总生存期差异。 结果：在45,818例患者（17,359例局部晚期激素受体阳性/HER2阴性乳腺癌，28,459例早期三阴性乳腺癌）中，局部晚期激素受体阳性/HER2阴性乳腺癌的6年总生存率显著更差（86.1%对比90.4%；风险比=1.63；p<0.0001）。在接受规范治疗的患者中，局部晚期激素受体阳性/HER2阴性乳腺癌患者的死亡风险相对高出35%（风险比=1.35；95%置信区间1.24-1.48；p<0.0001）。这些结果突显了尽管两类乳腺癌均被归类为病理预后分期IB期且接受了所有规范治疗，局部晚期激素受体阳性/HER2阴性乳腺癌的生存结局仍更差。 结论：解剖学疾病范围在解剖学分期与病理预后分期不一致的患者中仍是重要影响因素。未来病理预后分期系统的修订应考虑将局部晚期激素受体阳性/HER2阴性乳腺癌从IB期重新分类，以确保提供更准确的预后和生存信息。
肿瘤(癌症)患者之家