Clinical implication of subcategorizing T2 category into T2a and T2b in TNM staging of breast cancer. (12th October 2018)

• Record Type: Journal Article
• Authors: Jung, Jiwoong; Suh, Young Jin; Ko, Byung Kyun; Lee, Eun Sook; Kim, Eun‐Kyu; Paik, Nam Sun; Byun, Kyung Do; Hwang, Ki‐Tae
• Other Names: Ahn Sei Hyun investigator.; Noh Dong‐Young investigator.; Nam Seok Jin investigator.; Park Byeong‐Woo investigator.; Noh Woo Chul investigator.; Yoon Jung Han investigator.; Lee Soo Jung investigator.; Lee Eun Kyu investigator.; Jeong Joon investigator.; Han Sehwan investigator.; Park Ho Yong investigator.; Paik Nam‐Sun investigator.; Bae Young Tae investigator.; Lee Hyouk Jin investigator.; Park Heung kyu investigator.; Ko Seung Sang investigator.; Park Woo‐Chan investigator.; Jung Sung Hoo investigator.; Cho Se Heon investigator.; Kim Sei Joong investigator.; Oh Se Jeong investigator.; Kim Ku Sang investigator.; Park Chanheun investigator.; Song Byung Joo investigator.; Kim Je Ryong investigator.; Bae Jeoung Won investigator.; Kim Jeong‐Soo investigator.; Kang Sun Hee investigator.; Gwak Geumhee investigator.; Lee Jee Hyun investigator.; Kim Tae Hyun investigator.; Chang Myungchul investigator.; Kim Sung Yong investigator.; Lee Jung Sun investigator.; Song Jeong‐Yoon investigator.; Park Hai Lin investigator.; Min Sun Young investigator.; Yang Jung‐Hyun investigator.; Park Sung Hwan investigator.; Baek Jong‐Min investigator.; Kim Lee Su investigator.; Ryu Dong Won investigator.; Kim Kweon Cheon investigator.; Chung Min Sung investigator.; Park Hee Boong investigator.; Lim Cheol Wan investigator.; Choi Un Jong investigator.; Kwak Beom Seok investigator.; Park Young Sam investigator.; Shin Hyuk Jai investigator.; Choi Young Jin investigator.; Kim Doyil investigator.; Han Airi investigator.; Koh Jong Hyun investigator.; Choi Sangyong investigator.; Yoon Daesung investigator.; Choi Soo Youn investigator.; Chul Shin Hee investigator.; Kim Jae Il investigator.; Choi Jae Hyuck investigator.; Ryu Jin Woo investigator.; Ko Chang Dae investigator.; Lee Il Kyun investigator.; Lee Dong Seok investigator.; Choi Seunghye investigator.; Min Youn Ki investigator.; Jeon Young San investigator.; Park Eun‐Hwa investigator.;
• Is Part Of: Cancer medicine. Volume 7:Number 11(2018:Nov.)
• Page Start: 5514
• Page End: 5524
• Publication Date: 2018-10-12
• Subjects: breast neoplasms -- prognosis -- TNM staging -- tumor staging; 616.994005
• DOI: 10.1002/cam4.1831
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Regarding TNM staging in breast cancer, T2 category is currently not divided into subcategories even though it covers a wider range of tumor sizes than T1 category. Using Korean Breast Cancer Registry database, data of 41 071 women diagnosed as non‐metastatic T2 breast cancer between 2001 and 2014 were analyzed. Cutoff value for optimal tumor size was approximated by receiver operating characteristic (ROC) curve to subcategorize T2 tumors. Overall survival (OS) was compared between two subcategories. Median follow‐up period was 65 months. Of 41 071 patients, 4504 (11.0%) died. Based on ROC curve analysis, 3.0 cm was selected as the cutoff value. Five‐year OS rate was 91% in patients with breast tumors ≤3.0 cm (T2a) and 86% in patients with breast tumors >3.0 cm (T2b) (log‐rank P < 0.001). T2b subcategory showed worse OS than T2a subcategory regardless of node status (log‐rank P < 0.001 for all node categories). Within every subgroup defined by primary OS analysis covariates, T2b subcategory consistently showed worse outcome compared to T2a subcategory. By multivariate analysis, T2b subcategory was a significant independent prognostic factor of OS (hazard ratio: 1.26, 95% CI = 1.18‐1.34). T2 category of breast cancer could be subcategorized into T2a and T2b with a cutoff value of 3 cm. These subcategories definitely showed different OSs even after adjusted for known prognostic factors. Subcategorization of T2 category might be useful for predicting prognosis more accurately and tailoring adjuvant therapy. Abstract : Regarding TNM staging in breast cancer (BC), T2 category is currently not divided into subcategories even though it covers a wider range of tumor sizes than T1 category. In analyses of 34, 528 Korean T2 BC patients, we show that T2 category of BC could be subcategorized into T2a (2‐3cm) and T2b (3‐5cm) with a cutoff value of 3 cm. The survival difference between the two T2 subcategories is not fully explained by the model after adjusted for biologic risk factors incorporated into the 8th edition AJCC cancer staging for BC. More detailed anatomic classification might help us predict prognosis more accurately.