Novel molecular characterization of breast cancer with cellular markers has allowed a new classification that offers prognostic value, with predictive categories of disease aggressiveness. Biological factors have predictive and prognostic value in breast cancer patients. Our work evaluates the prognostic value of the bioscore among non-metastatic female breast cancer patients concerning disease-free survival (DFS).
We reviewed the clinical data of 317 female patients with non-metastatic surgically treated breast cancer from January 2015 to December 2018 presented at the Clinical Oncology Department of Assiut University Hospital. The biological variables include: pathologic stage (PS), T stage (T), nodal stage (N), grade (G), estrogen receptor (ER), progesterone receptors (PR), and human epidermal growth factor receptor (HER2) status. Univariate & two multivariate analyses were performed to identify variables associated with disease-free survival (DFS). Multiple staging system models were built for significant factors in both univariate and multivariate analyses: PS, PS + G, PS + G + E, T + N, T + N + G, T + N + G + E. The first one used the PS, which takes into account the combined T and N stage as a variable, while the second included T and N stages as separate variables. Model performance was quantified using Harrell’s concordance index (C-index) and the Akaike Information Criterion (AIC) was used to compare model fits.
The only significant factors in the univariate analysis were PS3, T2, T3, T4, N3, G2, G3, ER -ve, PR -ve, and HER2 –ve with Hazard Ratio (HR): 4.77, 2.52, 2.80, 5.59, 2.74, 6.92, 16.80, 3.08, 2.11, 0.53 respectively with significant P value (˂ 0.05). The factors which were significant in the first multivariate model were: PS3, G3, ER –ve, and in the second one were: T2, T4, N3, G3, and ER –ve. Two sets of models were built to determine the utility of combining variables. Models incorporating G and E status had the highest C-index (0.72) for (T+N + G + ER) in comparison with (0.69) for (PS+ G + ER) and the lowest AIC (953.01) for (T + N + G + E) and (966.9) for (PS + G + E).
Bioscore provides more optimistic prognostic stratification than the anatomic staging alone as regards DFS. It helps clinicians to provide patients with more personalized treatment options.
Legal entity responsible for the study
Faculty of Medicine Assiut University.
Has not received any funding.
All authors have declared no conflicts of interest.