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In a major departure from traditional anatomical staging, the eighth edition of the American Joint Committee on Cancer (AJCC) tumour, node, metastases (TNM) staging system has introduced a breast cancer Prognostic Stage that aims to incorporate and ultimately replace anatomical TNM staging for breast cancer.1 2 The newly developed Prognostic Stage combines anatomical TNM with tumour intrinsic biology, namely the Nottingham histological tumour grade1 and predictive biomarkers (oestrogen, progesterone and Her2 receptor expression), in addition to certain multigene assays in a subgroup of patients. The proposed Prognostic Stage aims to improve stratification of patients with respect to outcome.
We welcome the recognition of the well-validated power of grade as a prognostic tool.3 4 The role of hormone receptor and human epidermal growth factor receptor 2 (HER2) in predicting response to adjuvant systemic therapy is undisputed, and initial results from randomised clinical trials have produced level 1 evidence supporting the accuracy of certain multigene assays in identifying low-risk patients with breast …
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