The American Joint Committee on Cancer (AJCC) Breast Cancer Staging, Eighth Edition, is more Reflective of Cancer Biology than the Seventh Edition.

Abstract

The American Joint Committee on Cancer (AJCC) eighth-edition breast cancer staging system incorporating tumor grade, hormone/human epidermal growth factor receptor 2 (HER2) receptor status, and genomic assays has demonstrated better prognostic value than the seventh edition. Given the crucial role of cancer biology in prognosis, the authors hypothesized that the AJCC eighth-edition criteria offer better biologic differentiation between stages than the seventh edition. This study analyzed 696 breast cancer patients from The Cancer Genome Atlas (TCGA) and Text Information Extraction System (TIES) database, with complete information available for staging according to both the AJCC seventh- and eighth-edition criteria. The study indicated an increase in the number of patients classified as stage I in the eighth edition compared with the seventh edition, particularly in hormone-positive breast cancers. Furthermore, the eighth edition demonstrated improved discrimination in overall survival between stages I and II cancers. The eighth edition was able to distinguish significant differences in cell proliferation, intratumor heterogeneity, homologous recombination deficiency, and neoantigen load between stages I and II cancers. Moreover, the eighth edition more clearly differentiated immune cell infiltration between stages II and I cancer than the seventh edition. Finally, immune activity and gene expression of immune checkpoints such as PDCD1, PDL1, CTLA4, LAG3, TIGIT, and IDO1 and 2 showed a more pronounced difference between stages I and II cancers in the eighth edition than in the seventh edition. The AJCC eighth edition breast cancer staging system better distinguishes cancers with more aggressive biology than the seventh edition.