title: Evaluation of the stage IB designation of the American Joint Committee on Cancer staging system in breast cancer.
abstract: OBJECTIVE
  The seventh edition of the American Joint Committee on Cancer (AJCC) staging system for breast cancer differentiates patients with T1 tumors and lymph node micrometastases (stage IB) from patients with T1 tumors and negative nodes (stage IA). This study was undertaken to determine the utility of the stage IB designation.
  
  
  METHODS
  The following two cohorts of patients with breast cancer were identified: 3,474 patients treated at The University of Texas MD Anderson Cancer Center from 1993 to 2007 and 4,590 patients from the American College of Surgeons Oncology Group (ACOSOG) Z0010 trial. Clinicopathologic and outcomes data were recorded, and disease was staged according to the seventh edition AJCC staging system. Recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) were determined using the Kaplan-Meier method and compared using the log-rank test.
  
  
  RESULTS
  Median follow-up times were 6.1 years and 9.0 years for the MD Anderson Cancer Center and ACOSOG cohorts, respectively. In both cohorts, there were no significant differences between patients with stage IA and stage IB disease in 5- or 10-year RFS, DSS, or OS. Estrogen receptor (ER) status and grade significantly stratified patients with stage I disease with respect to RFS, DSS, and OS.
  
  
  CONCLUSIONS
  Among patients with T1 breast cancer, individuals with micrometastases and those with negative nodes have similar survival outcomes. ER status and grade are better discriminants of survival than the presence of small-volume nodal metastases. In preparing the next edition of the AJCC staging system, consideration should be given to eliminating the stage IB designation and incorporating biologic factors.
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA. eamitten@mdanderson.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Mittendorf
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Karla V
authors.initials: KV
authors.lastname: Ballman
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: McCall
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Min
authors.initials: M
authors.lastname: Yi
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Aysegul A
authors.initials: AA
authors.lastname: Sahin
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bedrosian
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Nora
authors.initials: N
authors.lastname: Hansen
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Sheryl
authors.initials: S
authors.lastname: Gabram
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Thelma
authors.initials: T
authors.lastname: Hurd
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Armando E
authors.initials: AE
authors.lastname: Giuliano
authors.affiliation: Elizabeth A. Mittendorf, Min Yi, Aysegul A. Sahin, Isabelle Bedrosian, and Kelly K. Hunt, The University of Texas MD Anderson Cancer Center, Houston; Thelma Hurd, The University of Texas at San Antonio, San Antonio, TX; Karla V. Ballman, Mayo Clinic, Rochester, MN; Linda M. McCall, Duke University, Durham, NC; Nora Hansen, Northwestern University, Chicago, IL; Sheryl Gabram, Emory University, Atlanta, GA; Armando E. Giuliano, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Kelly K
authors.initials: KK
authors.lastname: Hunt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism; D015203:Reproducibility of Results; D021701:Sentinel Lymph Node Biopsy; D014481:United States; D055815:Young Adult
chemical_list: D011960:Receptors, Estrogen