Validation of the Prognostic Stage of American Joint Committee on Cancer Eighth Edition Staging Manual in Invasive Lobular Carcinoma Compared to Invasive Ductal Carcinoma and Proposal of a Novel Score System

Purpose:The objective of this study was to evaluate the American Joint Committee on Cancer (AJCC) pathological prognostic stage among patients with invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) and to propose a modified score system if necessary. Methods:Women diagnosed with IDC and ILC during 2010-2015 in the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively identified. Disease-specific survival (DSS) and overall survival (OS) were estimated by Kaplan-Meier method. Predictive performances of different staging systems were evaluated based on Harrell concordance index (C-index) and Akaike Information Criterion (AIC). Multivariate Cox models were conducted to build preferable score systems. Results:A total of 184,541 female patients were included in the final analyses, with a median follow-up of 30.0 months. In IDC cohort, the pathological prognostic stage (C-index, 0.8281; AIC, 110274.5) was superior to the anatomic stage (C-index, 0.8125; AIC, 112537.0;P< 0.001 for C-index) in risk stratification with respect to DSS. In ILC cohort, the prognostic stage (C-index, 0.8281; AIC, 7124.423) didn't outperform the anatomic stage (C-index, 0.8324; AIC, 7144.818;P= 0.748 for C-index) with respect to DSS. Similar results were observed with respect to OS. The score system defined by anatomic stage plus grade plus estrogen receptor and progesterone receptor (AS+GEP) allows for better staging (C-index, 0.8085; AIC, 7178.448) for ILC patients. Conclusion:Compared with anatomic stage, the pathological prognostic stage provided more accurate stratification for patients with IDC, but not for patients with ILC. The AS+GEP score system may fit ILC tumors better.