Comparison of AJCC 7th edition (anatomic) vs AJCC 8th edition (prognostic) staging systems for breast cancer
Date of Award
Master of Medicine (MMed)
Dr. Shahin Sayed
Dr. Asim Jamal Shaikh
Dr Zahir Moloo
Pathology (East Africa)
Background; Staging is key for the appropriate management of breast cancer. It is based upon the size of tumour, status of lymph nodes and the presence or absence of distant metastasis, to provide an overall estimate of tumour burden. In its latest (8th) edition, the American Joint Committee on Cancer (AJCC) made a radical change in staging, creating a new prognostic staging system for breast cancer by adding biological factors to the purely anatomical based staging system of the prior editions.
Study Objectives; This study aimed to retrospectively evaluate the changes in staging between the AJCC 7th (anatomic) and AJCC 8th (prognostic) staging systems for breast cancer in our population and to compare the survival data between the two staging systems.
Methods; Records of invasive breast cancer patients who underwent upfront curative surgery at Aga Khan University Hospital, Nairobi between January 2008 and December 2019 were retrieved. The cases were staged into the anatomical and prognostic groups according to the AJCC 7th and 8th staging systems for breast cancer. Survival analysis was performed for the two groups using the Kaplan-Meier method and compared using the Log-rank test.
Results; Stage III patients made up the largest proportions (48.8% and 50.7% respectively) in both the AJCC 7th and AJCC 8th staging systems. A total of 65(17.0%) patients were upstaged, while 79(20.7%) were downstaged. Stage changes from AJCC 7th to 8th edition resulted in decreased stage II population and increase in the population of stages I and III patients. There were no significant differences observed in survival outcomes between the two staging systems.
Conclusions; The prognostic staging system discriminates patients into good or poor prognostic groups more than the borderline group. Our findings did not demonstrate significant differences in survival outcomes between the AJCC 7th and 8th staging systems in our population.
Abdi, I. M. (2021). Comparison of AJCC 7th edition (anatomic) vs AJCC 8th edition (prognostic) staging systems for breast cancer (Unpublished master's dissertation). Aga Khan University, East Africa.