Staging connected views for breast...

Staging connected views for breast cancer were expanded primarily to select similar collections of patients for treatment comparisons, rather than to determine prognosis. Jimenez-Lee and colleagues believe that breast cancer issues in breast cancer may be predicted more accurately from tumor characteristics that are poorly showed in current staging systems. They evolveed a prognostic tool based forward tumor biology and tested it in more than 400 patients.

The breast cancer severity scale (BCSS) is based forward the sum of points allocated for tumor diameter, number of positive lymph nodes, and hormone receptor status. undivided point was awarded for tumor diameter up to 1 cm couple points for tumors between 11 and 20 cm three points for those 21 to 50 cm and four points for tumors with a diameter greater than 51 cm Patients with single to three positive lymph nodes scored common point, those with four to nine positive nodes scored five points, and those with 10 or more positive nodes scored 10 points. If estrogen or progesterone receptors were absent, undivided point was given; if the one and the other hormone receptors were absent, sum of two units points were added to the score.

The researchers applied the scoring a whole to data on 417 patients with breast cancer who were treated at a university medical center between 1997 and 2002 The mean age of the patients was 57 years, and the median duration of follow-up was 20 month Using the American Joint Commission onward Cancer staging criteria, 171 patients were stage I, 190 were stage II, 28 were stage III, and 30 were stage IV. The mean BCS was 24 for patients with stage I cancer, 47 for those with stage II cancer, 79 for those with stage III cancer, and 70 for those with stage IV cancer.

All patients with stage I cancer survived for five years. The other overall five-year survival rates were 97 percent for patients with stage II cancer, 68 percent for those with stage III cancer, and 18 percent for those with stage IV cancer. For disease-free survival, the five-year rates were 95 percent for patients with stage I cancer, 91 percent for those with stage II cancer, and 55 percent for those with stage III cancer.

The BCS provided better prognostic information than conventional staging. A BCS score of seven points discriminated between patients with a virtuous prognosis and those with a poor prognosis. The five-year survival rate for patients with a BCS score below seven points was 92 percent compared with 44 percent for those with higher scores. This discrimination was smooth better when patients with stage IV were excluded: the five-year survival rate was 99 percent for patients with scores below seven points, compared with 75 percent for patients with higher scores. The comparable disease-free survival rates were 93 percent for patients with scores below seven points and 60 percent for patients with scores above seven points.

The authors end that the BCSS is a simple orderly disposition for determining overall survival and disease-free survival using readily available data. They believe that patients and physicians could use the scoring order to guide treatment decisions.

Jimenez-Lee R et al. Breast cancer severity score is an innovative connected view for prognosis. Am J Surg October 2003; 186:404-8

COPYRIGHT 2004 American Academy of Family Physicians

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