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Relevant impact of central pathology review on nodal classification in individual breast cancer patients.
- Source :
-
Annals of oncology : official journal of the European Society for Medical Oncology [Ann Oncol] 2012 Oct; Vol. 23 (10), pp. 2561-2566. Date of Electronic Publication: 2012 Apr 11. - Publication Year :
- 2012
-
Abstract
- Background: In the MIRROR study, pN0(i + ) and pN1mi were associated with reduced 5-year disease-free survival (DFS) compared with pN0. Nodal status (N-status) was assessed after central pathology review and restaging according to the sixth AJCC classification. We addressed the impact of pathology review.<br />Patients and Methods: Early favorable primary breast cancer patients, classified pN0, pN0(i + ), or pN1(mi) by local pathologists after sentinel node procedure, were included. We assessed the impact of pathology review on N-status (n = 2842) and 5-year DFS for those without adjuvant therapy (n = 1712).<br />Results: In all, 22% of the 1082 original pN0 patients was upstaged. Of the 623 original pN0(i + ) patients, 1% was downstaged, 26% was upstaged. Of 1137 patients staged pN1mi, 15% was downstaged, 11% upstaged. Originally, 5-year DFS was 85% for pN0, 74% for pN0(i + ), and 73% for pN1mi; HR 1.70 [95% confidence interval (CI) 1.27-2.27] and HR 1.57 (95% CI 1.16-2.13), respectively, compared with pN0. By review staging, 5-year DFS was 86% for pN0, 77% for pN0(i + ), 77% for pN1mi, and 74% for pN1 + .<br />Conclusion: Pathology review changed the N-classification in 24%, mainly upstaging, with potentially clinical relevance for individual patients. The association of isolated tumor cells and micrometastases with outcome remained unchanged. Quality control should include nodal breast cancer staging.
- Subjects :
- Female
Humans
Neoplasm Staging
Survival Rate
Breast Neoplasms pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1569-8041
- Volume :
- 23
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Annals of oncology : official journal of the European Society for Medical Oncology
- Publication Type :
- Academic Journal
- Accession number :
- 22495317
- Full Text :
- https://doi.org/10.1093/annonc/mds072