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Clinical and pathological stage discordance among 433,514 breast cancer patients.

ABSTRACT: BACKGROUND:We aim to determine clinical and pathological stage discordance rates and to evaluate factors associated with discordance. METHODS:Adults with clinical stages I-III breast cancer were identified from the National Cancer Data Base. Concordance was defined as cTN?=?pTN (discordance: cTN?pTN). Multivariate logistic regression was used to identify factors associated with discordance. RESULTS:Comparing clinical and pathological stage, 23.1% were downstaged and 8.7% were upstaged. After adjustment, factors associated with downstaging (vs concordance) included grade 3 (OR 10.56, vs grade 1) and HER2-negative (OR 3.79). Factors associated with upstaging (vs concordance) were grade 3 (OR 10.56, vs grade 1), HER2-negative (OR 1.25), and lobular histology (OR 2.47, vs ductal). ER-negative status was associated with stage concordance (vs downstaged or upstaged, OR 0.52 and 0.87). CONCLUSIONS:Among breast cancer patients, nearly one-third exhibit clinical-pathological stage discordance. This high likelihood of discordance is important to consider for counseling and treatment planning.

SUBMITTER: Plichta JK

PROVIDER: S-EPMC6768746 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Clinical and pathological stage discordance among 433,514 breast cancer patients.

Plichta Jennifer K JK Thomas Samantha M SM Sergesketter Amanda R AR Greenup Rachel A RA Fayanju Oluwadamilola M OM Rosenberger Laura H LH Tamirisa Nina N Hyslop Terry T Hwang E Shelley ES

American journal of surgery 20190718 4

<h4>Background</h4>We aim to determine clinical and pathological stage discordance rates and to evaluate factors associated with discordance.<h4>Methods</h4>Adults with clinical stages I-III breast cancer were identified from the National Cancer Data Base. Concordance was defined as cTN = pTN (discordance: cTN≠pTN). Multivariate logistic regression was used to identify factors associated with discordance.<h4>Results</h4>Comparing clinical and pathological stage, 23.1% were downstaged and 8.7% we ...[more]

PMID: 31350005

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Project description:IntroductionThe cancer stem cell (CSC) hypothesis states that tumours consist of a cellular hierarchy with CSCs at the apex driving tumour recurrence and metastasis. Hence, CSCs are potentially of profound clinical importance. We set out to establish the clinical relevance of breast CSC markers by profiling a large cohort of breast tumours in tissue microarrays (TMAs) using immunohistochemistry (IHC).MethodsWe included 4, 125 patients enrolled in the SEARCH population-based study with tumours represented in TMAs and classified into molecular subtype according to a validated IHC-based five-marker scheme. IHC was used to detect CD44/CD24, ALDH1A1, aldehyde dehydrogenase family 1 member A3 (ALDH1A3) and integrin alpha-6 (ITGA6). A 'Total CSC' score representing expression of all four CSC markers was also investigated. Association with breast cancer specific survival (BCSS) at 10 years was assessed using a Cox proportional-hazards model. This study was complied with REMARK criteria.ResultsIn ER negative cases, multivariate analysis showed that ITGA6 was an independent prognostic factor with a time-dependent effect restricted to the first two years of follow-up (hazard ratio (HR) for 0 to 2 years follow-up, 2.4; 95% confidence interval (95% CI), 1.2 to 4.8; P = 0.009). The composite 'Total CSC' score carried independent prognostic significance in ER negative cases for the first four years of follow-up (HR for 0 to 4 years follow-up, 1.3; 95% CI, 1.1 to 1.6; P = 0.006).ConclusionsBreast CSC markers do not identify identical subpopulations in primary tumours. Both ITGA6 and a composite Total CSC score show independent prognostic significance in ER negative disease. The use of multiple markers to identify tumours enriched for CSCs has the greatest prognostic value. In the absence of more specific markers, we propose that the effective translation of the CSC hypothesis into patient benefit will necessitate the use of a panel of markers to robustly identify tumours enriched for CSCs.

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Clinical and pathological stage discordance among 433,514 breast cancer patients.

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Clinical and pathological stage discordance among 433,514 breast cancer patients.

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