New Breast Cancer Staging System Emphasizes Importance of Tumor Biology

A new breast cancer staging system developed by a research team at the University of Texas MD Anderson Cancer Center finds including tumor biology is an important predictive indicator for women who go through neoadjuvant, or pre-surgical, therapy for breast cancer.

The Study

The Neo-Bioscore staging system that was published in JAMA Oncology, incorporates HER2 status, whereby allowing for more precise analytical stratification of all subtypes of breast cancer. Knowing a person’s individual response to different kinds of therapy could help doctors know which people would benefit from additional treatment.
Historically, individuals with breast cancer have been staged according to the size of the primary tumor, metastasis or disease in the lymph nodes at the time it presents. However, Dr. Elizabeth Mittendorf, the associate professor of Breast Surgical Oncology, states that failing to take into account the biology of the tumor is negligent and this has proven to be extremely important.

The findings of the study build on MD Anderson’s previous development of a breast cancer staging system, CPS+EG, which includes preclinical staging (CS), estrogen receptor status (E), grade (G), and the post treatment pathological stage (PS).

Dr. Mittendorf explains the CPS+EG system predated the routine use of trastuzumab or Herceptin in the neoadjuvant setting, so the staging system was restricted in its ability to provide analytical information for HER2-positive patients.

She stated, “Our initial study found that if we incorporate the clinical and pathological stage, then we can have more refined stratification of patients’ prognosis. We also found that biological factors such as estrogen receptor status and grade were important.”
Kelly Hunt, M.D., professor and chair ad interim at MD Anderson said, “This new staging system, Neo-Bioscore, which adds HER2 status, is another piece of the puzzle showing that the biology of breast cancer, with respect to prognosis, is critically important.”

For the study, the team researched 2,377 MD Anderson breast cancer patients from a prospectively maintained database. All of the patients were non-metastatic and treated with neoadjuvant chemotherapy. None of the patients in the study were included in the development or validating of the CPS+EG staging system.

The median age of a participant was 50 years of age and the follow up time was 4.2 years. The five year survival rate of the disease was 89 percent.

Researchers found out that the cohort validated previous findings; CPS+EG score improved prognostication of patients. It was also discovered that when Bioscore was applied, there was a shift from the previous CPS+EG scores.

Mittendorf said that prior to this new study, there was a lack of information in the literature incorporating biology into the staging of breast cancer.

Conclusion to the Study:

Dr. Mittendorf said in closing, “With this tool, I can give my patients the precise information they are looking for—a more refined prognosis. Also, with this data, we will know which patients are in greatest need of additional therapy. Hopefully these findings will result in more informed conversations between doctor and patients.”

With this information, Mittendorf and Hunt hope that guidelines for breast cancer staging will be updated to reflect the importance of biology in staging and patient prognosis.

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