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New staging systems improve prediction of breast cancer survival

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The application of CPS+EG scores and Neo-Bioscore following neoadjuvant chemotherapy better predicted survival for patients with breast cancer than AJCC 7th edition staging, according to a study presented at the Society of Surgical Oncology Annual Cancer Symposium.

“We sought to validate these staging systems in a national cohort and compare their performance to each other and to AJCC 7th edition staging,” John R. Bergquist, MD, MS, MA, general surgery resident at Mayo Clinic in Rochester, Minnesota, said in a press release.

John R. Bergquist

Retreatment clinical stage and posttreatment pathologic stage combined with ER status and tumor grade is known as the CSP+EG score. Researchers have proposed that accounting for these factors and ERBB2 status — known as Neo-Bioscore — can better assess OS than the AJCC 7th edition staging.

To validate these staging systems, Bergquist and colleagues analyzed data from the National Cancer Data Base on 43,320 women with invasive breast cancer who received neoadjuvant chemotherapy and survived more than 90 days after surgery from 2008 to 2012.

Researchers compared the clinical AJCC 7th edition, pathologic AJCC 7th edition, CPS+EG score and Neo-Bioscore based on concordance and integrated discrimination improvement (IDI).

All women had evaluable CPS+EG scores and 12,002 had evaluable Neo-Bioscore.

Five-year OS was 76% (95% CI, 75.4-76.5).

Both CPS+EG and Neo-Bioscore showed improved staging stratification compared with clinical or pathologic AJCC staging.

Concordance for CPS+EG score (0.724, standard error [SE] = 0.003) and Neo-Bioscore (0.744, SE = 0.008) showed marked improvement compared with AJCC clinical (0.645, SE = 0.003) and pathologic (0.676, SE = 0.004) staging (P < 0.001). Researchers also observed superior description for CPS+EG score (IDI 4.7%, 95% CI, 3.9-5.6) and Neo-Bioscore (IDI 6.7%, 95% CI, 5.2-8.5) compared with AJCC pathologic staging.

Comparisons of CPS+EG score and Neo-Bioscore yielded an IDI of 1% (95% CI, 0.5-1.5), which indicated that Neo-Bioscore improved survival discrimination over CPS+EG score.

“In a heterogenous national cohort of breast cancer patients, CPS+EG and Neo-Bioscore were found useful and substantially improved upon the AJCC 7th edition staging systems for patients treated with neoadjuvant chemotherapy,” the researchers wrote. “In cases where ERBB2 status was available, Neo-Bioscore provided superior staging discrimination to CPS+EG.” – by Chuck Gormley

For more information:

Bergquist, JR. Abstract 8. Presented at: Society of Surgical Oncology Annual Cancer Symposium; March 15-18, 2017; Seattle.

Disclosure: The researchers report no relevant financial disclosures.