Discriminatory ability and clinical utility of the AJCC7 and AJCC8 staging systems for breast cancer in a middle-income setting

Song, Chin-Vern and van Gils, Carla H. and Yip, Cheng-Har and Soerjomataram, Isabelle and Taib, Nur Aishah Mohd and See, Mee-Hoong and Lim, Alexander and Satar, Nur Fadhlina Abdul and Bhoo-Pathy, Nirmala (2023) Discriminatory ability and clinical utility of the AJCC7 and AJCC8 staging systems for breast cancer in a middle-income setting. Diagnostics, 13 (4). ISSN 2075-4418, DOI https://doi.org/10.3390/diagnostics13040674.

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(1) Background: Differences in access to biomarker testing and cancer treatment in resource-limited settings may affect the clinical utility of the AJCC8 staging system compared to the anatomical AJCC7 system. (2) Methods: A total of 4151 Malaysian women who were newly diagnosed with breast cancer from 2010 to 2020 were followed-up until December 2021. All patients were staged using the AJCC7 and AJCC8 systems. Overall survival (OS) and relative survival (RS) were determined. Concordance-index was used to compare the discriminatory ability between the two systems. (3) Results: Migration from the AJCC7 to AJCC8 staging system resulted in the downstaging of 1494 (36.0%) patients and the upstaging of 289 (7.0%) patients. Approximately 5% of patients could not be staged using the AJCC8 classification. Five-year OS varied between 97% (Stage IA) and 66% (Stage IIIC) for AJCC7, and 96% (Stage IA) and 60% (Stage IIIC) for AJCC8. Concordance-indexes for predicting OS using the AJCC7 and AJCC8 models were 0.720 (0.694-0.747) and 0.745 (0.716-0.774), and for predicting RS they were 0.692 (0.658-0.728) and 0.710 (0.674-0.748), respectively. (4) Conclusions: Given the comparable discriminatory ability between the two staging systems in predicting the stage-specific survival of women with breast cancer in the current study, the continued use of the AJCC7 staging system in resource-limited settings seems pragmatic and justifiable.

Item Type: Article
Uncontrolled Keywords: breast cancer; AJCC7; AJCC8; low- and middle-income countries; prognostic performance; clinical utility
Subjects: R Medicine
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Clinical Oncology Department
Faculty of Medicine > Social & Preventive Medicine
Faculty of Medicine > Surgery Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 27 Nov 2023 07:27
Last Modified: 27 Nov 2023 07:27
URI: http://eprints.um.edu.my/id/eprint/38740

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