Dong Woo Shin1, Jong-Chan Lee1, Jaihwan Kim1, Sang Myung Woo2, Woo Jin Lee2, Sung-Sik Han2, Sang-Jae Park2, Kui Son Choi3, Hyo Soung Cha3, Yoo-Seok Yoon4, Ho-Seong Han4, Eun Kyung Hong2, Jin-Hyeok Hwang5. 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. 5. Division of Gastroenterology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea. Electronic address: jhhwang@snubh.org.
Abstract
BACKGROUND & AIMS: The 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. METHODS: We 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. RESULTS: In 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). CONCLUSION: The 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).
BACKGROUND & AIMS: The 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. METHODS: We 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. RESULTS: In 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). CONCLUSION: The 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).
Authors: Thijs J Schouten; Lois A Daamen; Galina Dorland; Stijn R van Roessel; Vincent P Groot; Marc G Besselink; Bert A Bonsing; Koop Bosscha; Lodewijk A A Brosens; Olivier R Busch; Ronald M van Dam; Arantza Fariña Sarasqueta; Sebastiaan Festen; Bas Groot Koerkamp; Erwin van der Harst; Ignace H J T de Hingh; Martijn Intven; Geert Kazemier; Vincent E de Meijer; Vincent B Nieuwenhuijs; G Mihaela Raicu; Daphne Roos; Jennifer M J Schreinemakers; Martijn W J Stommel; M F van Velthuysen; Robert C Verdonk; Joanne Verheij; Helena M Verkooijen; Hjalmar C van Santvoort; I Quintus Molenaar Journal: Ann Surg Oncol Date: 2022-04-25 Impact factor: 4.339