Discordance in clinical versus pathological staging in breast cancer: Are we undermining the significance of accurate preoperative staging in the present era?
Shina Goyal, Linu Abraham Jacob, D Lokanatha, M C Suresh Babu, K N Lokesh, A H Rudresha, Smitha Saldanha, Usha Amirtham, Antony G F Thottian, L K Rajeev
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引用次数: 4
Abstract
Background: The present era of individualized treatment for breast cancer is influenced by the initial disease status including the anatomical extent, grade, and receptor status. An accurate preoperative staging is the basis of treatment planning and prognostication. Our study aims to determine the discordance between the preoperative clinical and the postoperative pathological stages of breast cancer patients.
Methodology: The medical records of all non-metastatic breast cancer patients from January 2017 to December 2018 who underwent upfront surgery were reviewed. They were staged as per the eighth AJCC and the concordance between the clinical (c) and pathological T (tumor), N (nodal), and final AJCC stage was studied. A Chi-square test was used to determine factors that significantly correlate with disease discordance.
Results: A total of 307 breast cancer patients were analyzed. Among these, 43.3% were hormone receptor-positive, 30.6% were Her2 positive and 26% were triple-negative. Overall stage discordance was seen in 48.5% (n = 149) patients (upstaging in 22.1%, downstaging in 26.4%). The discordance rate was 48.9% for T stage (cT versus pT) and 57.4% for N stage (cN versus pN). Among patients with clinically node-negative disease, 53.4% were found to have positive nodes on histopathology, while 27.2% had vice versa. Overall, the factors associated with upstaging were ER-positive, Her2 positive and triple-negative status (all p < 0.05), while none of the factors showed significant association with downstaging.
Conclusions: About half of breast cancer patients had discordance between clinical and pathological staging with higher discordance in the nodal stage. This changes the disease prognosis, and may also affect the offered surgical treatment and radiotherapy. Thus highlighting the need for a precise pre-operative staging. Also, this information will aid clinicians in discussions with patients, keeping in mind the likelihood of change in disease staging and management.
背景:乳腺癌的个体化治疗受到初始疾病状态的影响，包括解剖程度、分级和受体状态。准确的术前分期是治疗计划和预后的基础。我们的研究旨在确定乳腺癌患者术前临床分期与术后病理分期之间的不一致性。方法:回顾2017年1月至2018年12月接受前期手术的所有非转移性乳腺癌患者的医疗记录。按照第8期AJCC分期，研究临床(c)与病理T(肿瘤)、N(淋巴结)、最终AJCC分期的一致性。采用卡方检验确定与疾病不一致性显著相关的因素。结果:共分析了307例乳腺癌患者。其中激素受体阳性43.3%，Her2阳性30.6%，三阴性26%。48.5% (n = 149)患者出现总体分期不一致(分期上升为22.1%，分期下降为26.4%)。T期(cT vs pT)不一致率为48.9%，N期(cN vs pN)不一致率为57.4%。在临床淋巴结阴性的患者中，组织病理学上淋巴结阳性的占53.4%，反之占27.2%。总体而言，与抢先期相关的因素有er阳性、Her2阳性和三阴性状态(均为p)。结论:约有一半的乳腺癌患者临床分期与病理分期不一致，其中淋巴结分期不一致程度更高。这改变了疾病的预后，也可能影响所提供的手术治疗和放疗。因此强调了精确的术前分期的必要性。此外，这些信息将有助于临床医生与患者讨论，记住疾病分期和管理变化的可能性。
期刊介绍：
The recent expansion of work in the field of breast cancer inevitably will hasten discoveries that will have impact on patient outcome. The breadth of this research that spans basic science, clinical medicine, epidemiology, and public policy poses difficulties for investigators. Not only is it necessary to be facile in comprehending ideas from many disciplines, but also important to understand the public implications of these discoveries. Breast Disease publishes review issues devoted to an in-depth analysis of the scientific and public implications of recent research on a specific problem in breast cancer. Thus, the reviews will not only discuss recent discoveries but will also reflect on their impact in breast cancer research or clinical management.
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