Advanced Breast Cancer Definitions by Staging System Examined in the Breast Cancer Surveillance Consortium
Menée à partir de données du "Breast Cancer Surveillance Consortium" portant sur 52 496 femmes atteintes d'un cancer invasif du sein et âgées de 40 à 79 ans, cette étude définit ce qu'est un cancer du sein de stade avancé en analysant la sensibilité et la spécificité de trois systèmes de stadification pour prédire le risque à 5 ans de décès par la maladie
Background : Advanced breast cancer is an outcome used to evaluate screening effectiveness. The advanced cancer definition resulting in the best discrimination of breast cancer death has not been studied in a breast imaging population.
Methods : 52,496 women aged 40–79 years participating in the Breast Cancer Surveillance Consortium diagnosed with invasive cancer were staged using the eighth edition of American Joint Committee on Cancer (AJCC) anatomic and prognostic pathologic systems and Tomosynthesis Mammographic Imaging Screening Trial (TMIST) tumor categories. We calculated the area under the receiver operating characteristic curve (AUC) for predicting 5-year breast cancer death and the sensitivity and specificity for predicting 5-year breast cancer death for three advanced cancer classifications; anatomic stage IIB or higher, prognostic pathologic stage IIA or higher, and TMIST advanced cancer.
Results : The AUCs for predicting 5-year breast cancer death for AJCC anatomic stage, AJCC prognostic pathologic stage, and TMIST tumor categories were 0.826 (95% confidence interval [CI]=0.817, 0.835), 0.856 (95%CI = 0.846, 0.866), and 0.789 (95%CI = 0.780, 0.797), respectively. AJCC prognostic pathologic stage had statistically significantly better discrimination than AJCC anatomic stage (difference = 0.030, bootstrap 95%CI = 0.024, 0.037) and TMIST tumor categories (difference = 0.067, bootstrap 95%CI = 0.059, 0.075). The sensitivity and specificity for predicting 5-year breast cancer death for AJCC anatomic stage IIB or higher, AJCC prognostic pathologic stage IIA or higher, and TMIST advanced cancer were (72.6%, 76.7%, 96.1%) and (78.9%, 81.6%, 41.1%), respectively.
Conclusion : Defining advanced cancer as AJCC prognostic pathologic stage IIA or higher most accurately predicts breast cancer death. Use of this definition by investigators will facilitate comparing breast cancer screening effectiveness studies.
Journal of the National Cancer Institute , résumé, 2019