1. 羅喬，王明暘，郭文宏，黃俊升 台大醫院外科部一般外科乳房外科
乳癌AJCC 1B期臨床之應用價值探討： 單一醫學中心研究報告 Is AJCC stage 1B clinical meaningful? survival analysis from a single institution
羅喬，王明暘，郭文宏，黃俊升
台大醫院外科部一般外科乳房外科

2. Staging refers to the grouping of patients according to the extent of their disease.
NTUH yeqr survival rate
Staging is useful in determining the choice of treatment, estimating their prognosis.

3. 2010 ~ 2014 N=4592 Stage IA, IB, IIA N=2055 Stage IA N=1223 ( 30%)
Stage IB N= 54 ( 1.3%)
Stage IIA N=778 (21%)
2010 ~ 2014 N=4592
Stage IA, IB, IIA N=2055
Stage IA N=1223
Stage IB N= 54
Stage IIA N=778

4. American Society of Clinical Oncology and the College of American Pathologists recommend that sentinel lymph nodes (SLNs) be processed in 2.0-mm sections along the long axis and that all sections be subjected to hematoxylin and eosin (HE) staining.
Immunohistochemistry (IHC)
Identification of occult metastases in 10% to 15% of patients.

5. 2002 6th edition AJCC, difinition
macrometastases ( 2.0 mm), micrometastases ( 0.2 mm to 2.0 mm), and isolated tumor cells (ITCs; 0.2 mm) in axillary lymph nodes
7th edition: isolated : <200 cell
6th edition pT1NmiM0 and pT1N1M0 : stage IIA
7th edition pT1Nmi : stage IB

6. 6th edition pT1NmiM0 and pT1N1M0 : stage IIA
7th edition pT1Nmi : stage IB
2002 6th edition pT1NmiM0 and pT1N1M0 : stage IIA
2010 7th edition pT1Nmi : stage IB

7. Characteristic
Stage IA (n=1223)
Stage IB (n=54)
Stage IIA (n=778)
P*(IA v IB)
P*( IB v IIA)
No. of patients %
Age, years
Median
Range 52
17-89 51
31-77 53
18-91
0.804
0.471
Histology
IDC
1050
85.9% 50
92.6%
645
82.9%
0.161
0.063
ILC
4.1% 47
6.0%
0.130
IDC/ILC 12 1% 1
1.9%
1.5%
0.533
0.859
Other
111
9.1% 3
5.6% 74
9.5%
0.375
0.332
ER status
Positive
944
77.2% 42
77.8%
564
72.5%
0.919
0.399
Negative
272
22.2% 13
210
27.0%
0.752
0.640
Unknown 7
0.6% 0% 4
0.5%
0.577
0.597
PR status
762
62.3% 33
61.1%
434
55.8%
0.446
449
36.7% 21
38.9%
338
43.4%
0.746
0.513 6
0.8%
0.465
0.517
HER2 status
298
23.6%
204
26.2%
0.844
0.481
930
76%
574
73.8 %
0.854
0.3%
0.674 .
Adjuvant chemotherapy
Yes
429
35% 39
72.2%
536
68.9%
0.000
 0.609 No
794
65% 15
27.8%
242
31.1%
Adjuvant endocrine therapy
914
74.7% 41
75.9%
556
71.5%
308
25.2%
24.1%
222
28.5%
0.1%
0.834
Adjuvant target therapy
154
12.6%
22.3%
165
21.2%
0.040
0.860
1068
87.3%
77.7%
613
78.8%
0.042
Table 1. Clinicopathologic Characteristics of Patients With Stage IA, IB, or IIA Disease in The National Taiwan University Hospital
2010~ 2014 Cohort
2010 ~ 2014 N=4592
Stage IA, IB, IIA N=2055
Stage IA N=1223
Stage IB N= 54
Stage IIA N=778

8. N=2055 P=0.465 HR 95% CI P IA v IB 2.2 0.5-9.7 0.283 IB v IIA 0.7HR
95% CI P
IA v IB
2.2
0.283
IB v IIA
0.7
0.697
IIA v IA
1.2
0.280

9. 2010~ 2014 Stage Ib : N= 54 ER (+), Her2/Neu (-): N= 35
C/T : N= 24 (68.6%)
Without C/T : N=11 (31.4%)
survival difference ? Median 4.7 years (rage, 2.6~7.1 years)

10. P=0.4984

11. Discussion
Prognosis
Small primary tumor + Small volume metastasis in LN =
pathologically node negative
In stage Ib , ER (+) Her2/Neu (-) group
C/T did not improved overall survival

12. Conclusion In stage Ib , ER (+) Her2/Neu (-) group C/T can be omitted
guide treatment and stratify patients to prognosis
Biology >>> anatomy TNM stage
8th edition of AJCC staging -> Ib ?