OBJECTIVE: Consistent and reliable tumor staging is a critical factor in determining treatment strategy, selection of patients for adjuvant therapy, and for therapeutic clinical trials. The aim of this study was to evaluate the number and extent of pancreatic ductal adenocarcinoma (PDAC) cases that would have a different pT, pN, and overall stages based on the new eighth edition American Joint Committee on Cancer staging system when compared with the seventh edition. METHODS: Patients diagnosed with PDAC who underwent pancreaticoduodenectomy, total pancreatectomy, or distal pancreatectomy from 2007 to 2017 were retrospectively reviewed. A total of 340 cases were included. RESULTS: According to the seventh edition, the vast majority of tumors in our cohort were staged as pT3 tumors (88.2%). Restaging these cases with the new size-based pT system resulted in a more equal distribution among the 3 pT categories, with higher percentage of pT2 cases (55%). CONCLUSIONS: The newly adopted pT stage protocol for PDAC is clinically relevant, ensures a more equal distribution among different stages, and allows for a significant prognostic stratification. In contrast, the new pN classification (pN1 and pN2) based on the number of positive lymph nodes failed to show survival differences and remains controversial.
OBJECTIVE: Consistent and reliable tumor staging is a critical factor in determining treatment strategy, selection of patients for adjuvant therapy, and for therapeutic clinical trials. The aim of this study was to evaluate the number and extent of pancreatic ductal adenocarcinoma (PDAC) cases that would have a different pT, pN, and overall stages based on the new eighth edition American Joint Committee on Cancer staging system when compared with the seventh edition. METHODS:Patients diagnosed with PDAC who underwent pancreaticoduodenectomy, total pancreatectomy, or distal pancreatectomy from 2007 to 2017 were retrospectively reviewed. A total of 340 cases were included. RESULTS: According to the seventh edition, the vast majority of tumors in our cohort were staged as pT3tumors (88.2%). Restaging these cases with the new size-based pT system resulted in a more equal distribution among the 3 pT categories, with higher percentage of pT2 cases (55%). CONCLUSIONS: The newly adopted pT stage protocol for PDAC is clinically relevant, ensures a more equal distribution among different stages, and allows for a significant prognostic stratification. In contrast, the new pN classification (pN1 and pN2) based on the number of positive lymph nodes failed to show survival differences and remains controversial.
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
Authors: Dongguang Wei; Mohamed M Zaid; Matthew H Katz; Laura R Prakash; Michael Kim; Ching-Wei D Tzeng; Jeffrey E Lee; Anshuman Agrawal; Asif Rashid; Hua Wang; Gauri Varadhachary; Robert A Wolff; Eric P Tamm; Priya R Bhosale; Anirban Maitra; Eugene J Koay; Huamin Wang Journal: Pancreatology Date: 2020-11-14 Impact factor: 3.996