Loading
Since 2018 the American staging system gives breast cancer two stages: the anatomic stage from tumour size, nodes and spread, and a prognostic stage that also counts grade and the three receptors. Because triple-negative cancers are usually grade 3 and receptor negative, their prognostic stage is often a step higher than their anatomic stage; UK pages and NICE quote the anatomic TNM stage.
The eighth edition of the American Joint Committee on Cancer TNM classification for breast cancer, prepared by a multidisciplinary panel, kept the anatomic TNM stage so the system stays usable worldwide, but recognised the prognostic influence of grade, oestrogen and progesterone receptor expression and HER2 amplification and mandated their inclusion, and acknowledged gene expression panels: tumour biomarkers and a low Oncotype DX recurrence score can alter the stage, giving a flexible platform that will be updated online (Giuliano 2017). Validation in 3,327 patients with stage I to IIIC disease treated with surgery first at MD Anderson (2007 to 2013) found the prognostic stage moved 29.5 percent of patients up and 28.1 percent down relative to the anatomic stage, and stratified disease-specific survival better (C index 0.8357 against 0.737); in 54,727 patients in the California Cancer Registry (2005 to 2009) it upstaged 31.0 percent and downstaged 20.6 percent and again performed better (C index 0.8426), supporting its use (Weiss 2018). Patients treated with neoadjuvant systemic therapy were excluded from that validation, which matters for triple-negative disease, where most stage II and III patients now have chemotherapy first and the response at surgery (pathological complete response or residual cancer burden) is the stronger prognostic marker. Cancer Research UK describes the TNM 8th edition and the number stages in plain words and notes that the TNM system is the commonest way to stage breast cancer in the UK, with staging confirmed after surgery; UK clinicians do not usually quote the prognostic stage group.
Shares Residual cancer burden (RCB), Pathologic complete response (pCR), Breast cancer (all types), Triple-negative breast cancer (TNBC) and the tags breast, tnbc.
Shares Pathologic complete response (pCR), Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer and the tags breast, tnbc.
Shares Residual cancer burden (RCB), Pathologic complete response (pCR), Triple-negative breast cancer (TNBC) and the tags breast, tnbc.
Shares Breast cancer (all types), Triple-negative breast cancer (TNBC), HR-positive / HER2-negative breast cancer and the tags breast, tnbc.
Shares Breast cancer (all types), Triple-negative breast cancer (TNBC) and the tags breast, tnbc.
Shares Pathologic complete response (pCR), Triple-negative breast cancer (TNBC) and the tags breast, tnbc.
Shares Pathologic complete response (pCR), Triple-negative breast cancer (TNBC) and the tags breast, tnbc.
Shares Breast cancer (all types), Triple-negative breast cancer (TNBC) and the tags breast, tnbc.