Researchers at the University of Texas MD Anderson Cancer Center (Houston, TX) have developed a novel staging system that incorporates tumor biology as a critical prognostic indicator for women with breast cancer who undergo neoadjuvant therapy.
Currently, guidelines developed by the American Joint Committee on Cancer are the most commonly used method of breast cancer staging. However, staging using this system only considers the primary tumor size, positive lymph nodes at the time of diagnosis, and whether the disease has metastasized into other regions of the body. It does not consider the biology of the tumor, which has been shown to be critically important.
In a study published in JAMA Oncology, researchers led by Elizabeth Mittendorf, MD, University of Texas, MD Anderson Cancer Center (Houston TX), tested a newly developed breast cancer staging system, called Neo-Bioscore, that incorporates important tumor biology, particularly expression of ERBB2, which is associated with human epidermal growth factor receptor 2 (HER2) status. The new staging system functions as an update to a previous system developed by the researchers called CPS+EG, a clinical-pathologic scoring system incorporating estrogen receptor–negative disease and nuclear grade 3 tumor pathology. In the new model, estrogen receptor (ER) status was considered positive if it measured 1% or higher, as opposed to 10% or higher in the previous model, and ERBB2 status was taken into account.
The researchers conducted a retrospective study to evaluate 2377 patients who had received treatment for non-metastatic invasive breast cancer at MD Anderson. In patients found to be ERBB2-positive (n = 591), 5-year disease-specific survival estimates determined using the CPS+EG stage ranged from 52% to 98%, indicating a more refined prognostic categorization versus clinical or final pathological staging alone. In addition, incorporating ERBB2 status significantly improved risk stratification in ~75% of the study cohort and was able to more precisely determine disease-specific survival estimates.
Researchers concluded that the new system improves upon their previously validated CPS+EG staging system and can be applied in ERBB2-positive patients. They also recommended that treatment response and biologic markers be incorporated into the American Joint Committee on Cancer staging system.
The researchers conducted a retrospective study to evaluate 2377 patients who had received treatment for non-metastatic invasive breast cancer at MD Anderson. In patients found to be ERBB2-positive (n = 591), 5-year disease-specific survival estimates determined using the CPS+EG stage ranged from 52% to 98%, indicating a more refined prognostic categorization versus clinical or final pathological staging alone. In addition, incorporating ERBB2 status significantly improved risk stratification in ~75% of the study cohort and was able to more precisely determine disease-specific survival estimates.
Researchers concluded that the new system improves upon their previously validated CPS+EG staging system and can be applied in ERBB2-positive patients. They also recommended that treatment response and biologic markers be incorporated into the American Joint Committee on Cancer staging system.
