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- Title
Development and Methodological Validation of a Modified Staging System for de Novo Metastatic Breast Cancer.
- Authors
Berg, Tobias; Jensen, Maj-Britt; Rossing, Maria; Bechmann, Troels; Donskov, Frede; Knoop, Ann Søegaard; Ejlertsen, Bent
- Abstract
This cohort study performs an external validation of a novel system for understanding outcomes of de novo metastatic breast cancer. Key Points: Question: Is a new method for prognostication of de novo metastatic breast cancer valid in an external cohort? Findings: In this cohort study of 1859 participants, the new method, when applied to a Danish, nationwide cohort of patients with de novo metastatic breast cancer, divided patients with stage IV cancer into prognostically distinct subgroups. Meaning: These findings provide additional robustness to the implementation of the new system by the American Joint Committee on Cancer staging system for breast cancer. Importance: Validation of a new method for prognostication of de novo metastatic breast cancer (dnMBC) to better reflect the heterogenecity of the disease. Objective: To perform external methodological validation of the Plichta staging system, a novel prognostic system for de novo metastatic breast cancer (dnMBC). Design, Setting, and Participants: This retrospective cohort study used a multicenter, nationwide, population-based Danish Breast Cancer Group database to validate the new method. Participants were patients with dnMBC diagnosed between 2010 and 2019. Data were analyzed from April to June 2023. Main outcomes and measures: A recursive partitioning analysis (RPA) was performed, as demonstrated by Plichta and colleagues, to group patients with similar overall survival (OS) based on clinical factors. The main outcome was to group patients into 4 prognostic groups based on 3-year OS as stage IVa, greater than 70%; stage IVb, 50% to 70%; stage IVc, 25% to less than 50%; or stage IVd, less than 25%. Bootstrapping was applied for 1000 iterations, with final stage assignments based on the most commonly occurring assignment. Results: A total of 1859 women were included with a median (IQR) age of 69 (57-77) years. With a median potential follow-up of 89.9 (95% CI, 86.4-95.1) months and a median OS of 31.7 (95% CI, 29.5-34.1) months, the RPA stratified patients into 10 groups, with organ sites, estrogen receptor status, and human epidermal growth factor receptor 2 status as the key clinical factors. Three-year survival rates ranged from 62% (95% CI, 56%-69%) to 8% (95% CI, 3%-21%), which were further combined into 3 stage groups: IVb, 59.4% (95% CI, 56.2%-62.8%); IVc, 39.4% (95% CI, 36.2%-43.0%); and IVd, 15.4% (95% CI, 11.2%-21.3%) (P <.001). Following bootstrapping, an IVa group emerged, resulting in 4 stage groups with separate 3-year OS rates identified as IVa, 75.8% (95% CI, 67.8%-84.7%); IVb, 58.8% (95% CI, 55.5%-62.3%); IVc, 39.2% (95% CI, 35.8%-43.0%); and IVd, 14.4% (95% CI, 10.8%-19.4%) (P <.001). Conclusions and relevance: These findings provide external and independent validation of the methods applied in the novel Plichta staging system for dnMBC. This could guide future revisions of the current American Joint Committee on Cancer staging guidelines and may be incorporated as a stratification factor in clinical trials.
- Subjects
DENMARK; BREAST cancer prognosis; BREAST tumors; RETROSPECTIVE studies; REPORTING of diseases; CANCER patients; DESCRIPTIVE statistics; METASTASIS; LONGITUDINAL method; KAPLAN-Meier estimator; LOG-rank test; RESEARCH methodology; MEDICAL records; ACQUISITION of data; RESEARCH; TUMOR classification; CONFIDENCE intervals; DATA analysis software; GENETICS; OVERALL survival
- Publication
JAMA Network Open, 2024, Vol 7, Issue 3, pe242174
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.2174