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'''Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition) '''  
'''Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition) '''  
[[Image:Prognostic group.png|center|600px|thumb|<big>'''Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition).'''  '''The diagram is the authors' ([[User:Soroush Seifirad|Soroush Seifirad]]) own work.'''</big>]]
[[Image:Prognostic group.png|center|600px|thumb|<big>'''Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition).'''  '''The diagram is the authors' ([[User:Soroush Seifirad|Soroush Seifirad]]) own work.'''</big>]]
{| class="wikitable"
|Tis
|N0
|M0
|0
|-
|-
|T1
|N0
|M0
|IA
|-
|-
|T0
|N1mi
|M0
|IB
|-
|T1
|N1mi
|M0
|IB
|-
|-
|T0
|N1
|M0
|IIA
|-
|T1
|N1
|M0
|IIA
|-
|T2
|N0
|M0
|IIA
|-
|-
|T2
|N1
|M0
|IIB
|-
|T3
|N0
|M0
|IIB
|-
|-
|T0
|N2
|M0
|IIIA
|-
|T1
|N2
|M0
|IIIA
|-
|T2
|N2
|M0
|IIIA
|-
|T3
|N1
|M0
|IIIA
|-
|T3
|N2
|M0
|IIIA
|-
|-
|T4
|N0
|M0
|IIIB
|-
|T4
|N1
|M0
|IIIB
|-
|T4
|N2
|M0
|IIIB
|-
|-
|Any T
|N3
|M0
|IIIC
|-
|-
|Any T
|Any N
|M1
|'''IV'''
|}
{| class="wikitable"
|Tis N0 M0
|Any
|Any
|Any
|Any
|0
|-
|-
| rowspan="8" |T1* N0 M0
T0 N1mi M0
T1* N1mi M0
| rowspan="8" |G1
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="2" |Negative
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="2" |Negative
|Positive
|IA
|-
|Negative
|IB
|-
| rowspan="8" |T1* N0 M0
T0 N1mi M0
T1* N1mi M0
| rowspan="8" |G2
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="2" |Negative
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="2" |Negative
|Positive
|IA
|-
|Negative
|IB
|-
| rowspan="8" |T1* N0 M0
T0 N1mi M0
T1* N1mi M0
| rowspan="8" |G3
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="2" |Negative
|Positive
|IA
|-
|Negative
|IA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IA
|-
|Negative
|IB
|-
| rowspan="2" |Negative
|Positive
|IB
|-
|Negative
|IB
|-
|-
| rowspan="8" |T0 N1¶ M0
T1* N1¶ M0
T2 N0 M0
| rowspan="8" |G1
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIA
|-
| rowspan="8" |T0 N1¶ M0
T1* N1¶ M0
T2 N0 M0
| rowspan="8" |G2
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIB
|-
| rowspan="8" |T0 N1¶ M0
T1* N1¶ M0
T2 N0 M0
| rowspan="8" |G3
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIB
|-
| rowspan="2" |Negative
|Positive
|IIB
|-
|Negative
|IIB
|-
|-
| rowspan="8" |T2 N1Δ M0
T3 N0 M0
| rowspan="8" |G1
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIB
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIB
|-
| rowspan="2" |Negative
|Positive
|IIB
|-
|Negative
|IIB
|-
| rowspan="8" |T2 N1Δ M0
T3 N0 M0
| rowspan="8" |G2
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIA
|-
| rowspan="2" |Negative
|Positive
|IIA
|-
|Negative
|IIB
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIB
|-
| rowspan="2" |Negative
|Positive
|IIB
|-
|Negative
|IIIB
|-
| rowspan="8" |T2 N1Δ M0
T3 N0 M0
| rowspan="8" |G3
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IB
|-
|Negative
|IIB
|-
| rowspan="2" |Negative
|Positive
|IIB
|-
|Negative
|IIB
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIB
|-
|Negative
|IIIA
|-
| rowspan="2" |Negative
|Positive
|IIIA
|-
|Negative
|IIIB
|-
|-
| rowspan="8" |T0 N2 M0
T1* N2 M0
T2 N2 M0
T3 N1Δ M0
T3 N2 M0
| rowspan="8" |G1
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIIA
|-
| rowspan="2" |Negative
|Positive
|IIIA
|-
|Negative
|IIIA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIIA
|-
| rowspan="2" |Negative
|Positive
|IIIA
|-
|Negative
|IIIB
|-
| rowspan="8" |T0 N2 M0
T1* N2 M0
T2 N2 M0
T3 N1Δ M0
T3 N2 M0
| rowspan="8" |G2
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIIA
|-
| rowspan="2" |Negative
|Positive
|IIIA
|-
|Negative
|IIIA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIA
|-
|Negative
|IIIA
|-
| rowspan="2" |Negative
|Positive
|IIIA
|-
|Negative
|IIIB
|-
| rowspan="8" |T0 N2 M0
T1* N2 M0
T2 N2 M0
T3 N1Δ M0
T3 N2 M0
| rowspan="8" |G3
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IIB
|-
|Negative
|IIIA
|-
| rowspan="2" |Negative
|Positive
|IIIA
|-
|Negative
|IIIA
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIIA
|-
|Negative
|IIIB
|-
| rowspan="2" |Negative
|Positive
|IIIB
|-
|Negative
|IIIC
|-
|-
| rowspan="8" |T4 N0 M0
T4 N1Δ M0
T4 N2 M0
Any T N3 M0
| rowspan="8" |G1
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IIIA
|-
|Negative
|IIIB
|-
| rowspan="2" |Negative
|Positive
|IIIB
|-
|Negative
|IIIB
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIIB
|-
|Negative
|IIIB
|-
| rowspan="2" |Negative
|Positive
|IIIB
|-
|Negative
|IIIC
|-
| rowspan="8" |T4 N0 M0
T4 N1Δ M0
T4 N2 M0
Any T N3 M0
| rowspan="8" |G2
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IIIA
|-
|Negative
|IIIB
|-
| rowspan="2" |Negative
|Positive
|IIIB
|-
|Negative
|IIIB
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIIB
|-
|Negative
|IIIB
|-
| rowspan="2" |Negative
|Positive
|IIIB
|-
|Negative
|IIIC
|-
| rowspan="8" |T4 N0 M0
T4 N1Δ M0
T4 N2 M0
Any T N3 M0
| rowspan="8" |G3
| rowspan="4" |Positive
| rowspan="2" |Positive
|Positive
|IIIB
|-
|Negative
|IIIB
|-
| rowspan="2" |Negative
|Positive
|IIIB
|-
|Negative
|IIIB
|-
| rowspan="4" |Negative
| rowspan="2" |Positive
|Positive
|IIIB
|-
|Negative
|IIIC
|-
| rowspan="2" |Negative
|Positive
|IIIC
|-
|Negative
|IIIC
|-
|-
|Any T Any N M1
|Any
|Any
|Any
|Any
|IV
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 19:03, 1 April 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Mirdula Sharma, MBBS [3]

Overview

If left untreated, 22% of patients with breast cancer may regress. Common complications of breast cancer include metastasis. Prognosis is generally good with treatment.

Natural History

  • There is a theory that up to 22% of small (radiographically detected) breast tumors regress, based on an analysis in a large population.[1] The study is supported by NCI's SEER data.[2]
  • The natural history of breast cancer is extremely variable ranging from indolent cancers to aggressive cancers that can metastasize with fatal consequences.[3]

Prognosis

The prognosis and treatment options depend on the following:

Nottingham Prognostic Index

The Nottingham prognostic index (NPI) is used to determine prognosis following surgery for breast cancer. Its value is calculated using three pathological criteria: the size of the lesion; the number of involved lymph nodes; and the grade of the tumor.[4]

Calculation

The index is calculated using the formula:

NPI = [0.2 x S] + N + G

Where:

  • S is the size of the index lesion in centimetres
  • N is the node status: 0 nodes = 1, 1-4 nodes = 2, >4 nodes = 3
  • G is the grade of tumour: Grade I =1, Grade II =2, Grade III =3

Interpretation

Score 5-year survival
2.0 to 2.4 93%
2.5 to 3.4 85%
3.5 to 5.4 70%
> 5.4 50%

Estimated five year survival rates:[5]

stage I: ~87%
stage II: ~75%
stage III: ~46%
stage IV: ~13%

AJCC clinical prognosis categorization

  • The 8th revision of AJCC staging system for breast cancer has been extensively modified.
  • Rather than classic TNM system, other characteristics of tumors such as pathologic grade, the presence of ER, PR, hormone receptors as well as presence of certain genetic mutations such as HER2 has been integrated into the latest revision.
  • Patients has been assigned to clinical prognosis stages with respect to the above-mentioned criteria.

Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition)

Approach to determine the clinical prognostic stage group of the patients according to the AJCC staging recommendations for breast cancer (8th edition). The diagram is the authors' (Soroush Seifirad) own work.
Tis N0 M0 0
T1 N0 M0 IA
T0 N1mi M0 IB
T1 N1mi M0 IB
T0 N1 M0 IIA
T1 N1 M0 IIA
T2 N0 M0 IIA
T2 N1 M0 IIB
T3 N0 M0 IIB
T0 N2 M0 IIIA
T1 N2 M0 IIIA
T2 N2 M0 IIIA
T3 N1 M0 IIIA
T3 N2 M0 IIIA
T4 N0 M0 IIIB
T4 N1 M0 IIIB
T4 N2 M0 IIIB
Any T N3 M0 IIIC
Any T Any N M1 IV
Tis N0 M0 Any Any Any Any 0
T1* N0 M0

T0 N1mi M0 T1* N1mi M0

G1 Positive Positive Positive IA
Negative IA
Negative Positive IA
Negative IA
Negative Positive Positive IA
Negative IA
Negative Positive IA
Negative IB
T1* N0 M0

T0 N1mi M0 T1* N1mi M0

G2 Positive Positive Positive IA
Negative IA
Negative Positive IA
Negative IA
Negative Positive Positive IA
Negative IA
Negative Positive IA
Negative IB
T1* N0 M0

T0 N1mi M0 T1* N1mi M0

G3 Positive Positive Positive IA
Negative IA
Negative Positive IA
Negative IA
Negative Positive Positive IA
Negative IB
Negative Positive IB
Negative IB
T0 N1¶ M0

T1* N1¶ M0 T2 N0 M0

G1 Positive Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIA
Negative Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIA
T0 N1¶ M0

T1* N1¶ M0 T2 N0 M0

G2 Positive Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIA
Negative Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIB
T0 N1¶ M0

T1* N1¶ M0 T2 N0 M0

G3 Positive Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIA
Negative Positive Positive IIA
Negative IIB
Negative Positive IIB
Negative IIB
T2 N1Δ M0

T3 N0 M0

G1 Positive Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIB
Negative Positive Positive IIA
Negative IIB
Negative Positive IIB
Negative IIB
T2 N1Δ M0

T3 N0 M0

G2 Positive Positive Positive IB
Negative IIA
Negative Positive IIA
Negative IIB
Negative Positive Positive IIA
Negative IIB
Negative Positive IIB
Negative IIIB
T2 N1Δ M0

T3 N0 M0

G3 Positive Positive Positive IB
Negative IIB
Negative Positive IIB
Negative IIB
Negative Positive Positive IIB
Negative IIIA
Negative Positive IIIA
Negative IIIB
T0 N2 M0

T1* N2 M0

T2 N2 M0

T3 N1Δ M0 T3 N2 M0

G1 Positive Positive Positive IIA
Negative IIIA
Negative Positive IIIA
Negative IIIA
Negative Positive Positive IIA
Negative IIIA
Negative Positive IIIA
Negative IIIB
T0 N2 M0

T1* N2 M0

T2 N2 M0

T3 N1Δ M0 T3 N2 M0

G2 Positive Positive Positive IIA
Negative IIIA
Negative Positive IIIA
Negative IIIA
Negative Positive Positive IIA
Negative IIIA
Negative Positive IIIA
Negative IIIB
T0 N2 M0

T1* N2 M0

T2 N2 M0

T3 N1Δ M0 T3 N2 M0

G3 Positive Positive Positive IIB
Negative IIIA
Negative Positive IIIA
Negative IIIA
Negative Positive Positive IIIA
Negative IIIB
Negative Positive IIIB
Negative IIIC
T4 N0 M0

T4 N1Δ M0

T4 N2 M0 Any T N3 M0

G1 Positive Positive Positive IIIA
Negative IIIB
Negative Positive IIIB
Negative IIIB
Negative Positive Positive IIIB
Negative IIIB
Negative Positive IIIB
Negative IIIC
T4 N0 M0

T4 N1Δ M0

T4 N2 M0 Any T N3 M0

G2 Positive Positive Positive IIIA
Negative IIIB
Negative Positive IIIB
Negative IIIB
Negative Positive Positive IIIB
Negative IIIB
Negative Positive IIIB
Negative IIIC
T4 N0 M0

T4 N1Δ M0

T4 N2 M0 Any T N3 M0

G3 Positive Positive Positive IIIB
Negative IIIB
Negative Positive IIIB
Negative IIIB
Negative Positive Positive IIIB
Negative IIIC
Negative Positive IIIC
Negative IIIC
Any T Any N M1 Any Any Any Any IV

References

  1. ↑ Zahl PH, Maehlen J, Welch HG (2008). "The natural history of invasive breast cancers detected by screening mammography". Arch Intern Med. 168 (21): 2311–6. doi:10.1001/archinte.168.21.2311. PMID 19029493.
  2. ↑ Jatoi I, Anderson WF (2009). "Breast cancer overdiagnosis with screening mammography". Arch Intern Med. 169 (10): 999–1000, author reply 1000-1. doi:10.1001/archinternmed.2009.95. PMC 2768420. PMID 19468099.
  3. ↑ Breast Cancer. Cleveland Clinic (2015) http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/hematology-oncology/breast-cancer/ Accessed on January 18 2016
  4. ↑ Nottingham Prognostic Index. Wikipedia(2016) https://en.wikipedia.org/wiki/Nottingham_Prognostic_Index Accessed on january 16, 2016
  5. ↑ Breast Cancer. RadioPedia (2015) http://radiopaedia.org/articles/breast-cancer-staging Accessed on January 16, 2016

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