In breast cancer staging, the AJCC 8th edition introduced a 'Prognostic Stage' that incorporates biologic factors alongside anatomic TNM. Which combination of factors is now used to assign Prognostic Stage Group?
- A TNM + ER/PR/HER2 status + Oncotype DX Recurrence Score
- B TNM + ER/PR/HER2 status + histological grade ✓
- C TNM + Ki-67 index + lymphovascular invasion
- D TNM + Oncotype DX score alone
Correct answer: B. TNM + ER/PR/HER2 status + histological grade
Explanation
The AJCC 8th edition Prognostic Stage for breast cancer combines anatomic T, N, M with ER status, PR status, HER2 status, and histological grade. This allows patients with favorable biologic profiles to be down-staged and those with unfavorable profiles to be up-staged relative to pure anatomic grouping. Oncotype DX may inform chemotherapy decisions but is not part of the AJCC Prognostic Stage formula. Ki-67 and lymphovascular invasion are prognostic but not incorporated into the AJCC table.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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