Validation of the American Joint Committee on Cancer 8th edition staging system for the pancreatic ductal adenocarcinoma |
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| Affiliation: | 1. Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea;2. Center for Liver Cancer, National Cancer Center, Goyang, South Korea;3. Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Goyang, South Korea;4. Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea;1. Department of Obstetrics and Gynecology, Spedali Civili of Brescia, Piazzale Spedali Civili 1, Brescia, 25126, Italy;2. Department of Obstetrics and Gynecology, University of Brescia, Italy;3. Department of Pathology, Spedali Civili of Brescia, Italy;4. Department of Radiotherapy, Spedali Civili of Brescia, Italy;1. Scandinavian Surgical Outcomes Research Group (SSORG), Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 416 85, Gothenburg, Sweden;2. Region Västra Götaland, Sahlgrenska University Hospital, Department of Pediatric Oncology, 416 85, Gothenburg, Sweden;3. Region Västra Götaland, Sahlgrenska University Hospital, Department of Surgery, 416 85, Gothenburg, Sweden;4. Department of Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg University, 405 30, Gothenburg, Sweden;5. Center for Health and Performance, Institute of Food, Nutrition, and Sports Science, University of Gothenburg, 405 30, Gothenburg, Sweden;6. Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Geriatrics, and Emergency Medicine, 416 85, Gothenburg, Sweden;7. Health Metrics Unit, The Sahlgrenska Academy, University of Gothenburg, Sweden;1. Department of Obstetrics and Gynaecology, Institute Alix de Champagne University Hospital, Reims, France;2. Department of Obstetrics and Gynaecology, Centre Hospitalier Régional Universitaire de Tours, Hôpital Bretonneau, Tours, France;3. INSERM U1069, Université François-Rabelais, Tours, France;4. Department of Obstetrics and Gynecology, Hopital Nord, APHM, Marseilles, France;5. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Pierre and Marie Curie, Paris 6, Institut Universitaire de Cancérologie (IUC), France;6. INSERM UMR S 938, Université Pierre et Marie Curie, Paris, France;7. Department of Obstetrics and Gynaecology, Centre Hospitalier Intercommunal, Créteil, France;8. Faculté de Médecine de Créteil UPEC, Paris XII, France;1. Department of Surgery, Catharina Hospital Eindhoven, the Netherlands;2. GROW: School of Oncology and Developmental Biology, University of Maastricht, Maastricht, the Netherlands;1. Republican Centre for Thyroid Tumours, Department of Pathology, Nezavisimosty Av., 64, 220013, Minsk, Belarus;2. Republican Centre for Thyroid Tumours, Head and Neck Surgery Department, Nezavisimosty Av., 64, 220013, Minsk, Belarus;3. United Institute of Informatics Problems, National Academy of Sciences of Belarus, Surganova St. 6, 220012, Minsk, Belarus;4. New York Ear, Nose and Throat Institute, 1810 Voorhies Ave, Brooklyn, NY, 11235, United States;5. Department of Surgery, University of Hong Kong, Hong Kong;6. School of Medicine and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, 4222, Australia |
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| Abstract: | Background & aimsThe American Joint Commission on Cancer (AJCC) 8th edition staging system for pancreatic ductal adenocarcinoma (PDA) contains several significant changes. This study aimed to validate the AJCC 8th edition staging system of PDA.MethodsWe analyzed patients with resected PDA between 2001 and 2017 using the Korean Pancreatic Cancer (K-PaC) registry. Overall survival (OS) was estimated using the Kaplan-Meier survival curves and compared via the log-rank test.ResultsIn total, 701 resected PDA patients were identified. During a median follow-up of 24.5 months, the median OS was 21.7 months. Meanwhile, the median OS of each stage according to the AJCC 8th edition was 73.5 months (stage IA), 41.9 months (stage IB), 24.2 months (stage IIA), 18.3 months (stage IIB), and 16.8 months (stage III). However, the new N-category (pN1 vs. pN2) did not subdivide prognosis, although the lymph node ratio (i.e., the ratio of the number of LN involved to the number of examined LN) did. Although pT3 and pN2 belong under stage III, pN2 has a significantly longer median OS than pT3 (16.9 months vs 11.2 months; p < 0.01).ConclusionThe AJCC 8th edition staging system appropriately stratifies the prognosis of PDA patients. However, the cutoff of the N-category is not statistically valid, and the new stage III includes a heterogeneous category (pN2 and pT4). Therefore, we propose that stage III be divided into stage IIIA (Tany N2 M0) and stage IIIB (T4 Nany M0). |
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