Wooil Kwon1, Taesung Park2, Jin He3, Ryota Higuchi4, Donghee Son5, Seung Yeoun Lee5, Jaeri Kim1, Yoonhyeong Byun1, Hongbeom Kim1, Sun-Whe Kim1, Christopher L Wolfgang3, Masakazu Yamamoto4, Jin-Young Jang6. 1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. 2. Department of Bioinformatics, Seoul National University College of Natural Sciences, Seoul, Korea. 3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 4. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 5. Department of Mathematics and Statistics, Sejong University College of Natural Sciences, Seoul, Korea. 6. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. jangjy4@snu.ac.kr.
Abstract
BACKGROUND: The new T1 pancreatic cancer by the eighth edition of the AJCC staging system discards the concept of "extension beyond the pancreas" and focuses on size only. Furthermore, the new T1 is divided into T1a, T1b, and T1c based on size. The evidence pertaining to these changes has not been evaluated. This is to evaluate the feasibility of the new T1 definition in the pancreas head cancer cohort. METHODS: Data from 540 patients with T1 pancreatic ductal adenocarcinoma as defined by the eighth edition were collected from Korea, Japan, and the USA. Invasive IPMNs were excluded. Survival analyses were performed. RESULTS: Of the 540 patients, 181 patients were T1 according to the seventh edition and 359 were down-staged to T1 from the former T3 because the concept of "extension beyond the pancreas" was discarded. The 5-year survival rate and the median survival of T1 patients were 30.6% and 27 months, respectively. Comparing tumors that extend beyond the pancreas (new T1) and those confined within the pancreas (original T1), the latter showed significantly longer median survival (43 vs. 24 months, p < 0.001). In terms of T1a/b/c, there were no significant differences in survival. Using MaxStat, subdividing into two groups using 1.1 cm as the cut-off value, yielded significantly discrete prognostic groups (p < 0.001). CONCLUSION: The new T1 definition may be more practical, but the implications of the concept of "extension beyond the pancreas" should be re-investigated. Further, the subcategorization of T1a/b/c may not be adequate and may require revision or deletion.
BACKGROUND: The new T1 pancreatic cancer by the eighth edition of the AJCC staging system discards the concept of "extension beyond the pancreas" and focuses on size only. Furthermore, the new T1 is divided into T1a, T1b, and T1c based on size. The evidence pertaining to these changes has not been evaluated. This is to evaluate the feasibility of the new T1 definition in the pancreas head cancer cohort. METHODS: Data from 540 patients with T1 pancreatic ductal adenocarcinoma as defined by the eighth edition were collected from Korea, Japan, and the USA. Invasive IPMNs were excluded. Survival analyses were performed. RESULTS: Of the 540 patients, 181 patients were T1 according to the seventh edition and 359 were down-staged to T1 from the former T3 because the concept of "extension beyond the pancreas" was discarded. The 5-year survival rate and the median survival of T1 patients were 30.6% and 27 months, respectively. Comparing tumors that extend beyond the pancreas (new T1) and those confined within the pancreas (original T1), the latter showed significantly longer median survival (43 vs. 24 months, p < 0.001). In terms of T1a/b/c, there were no significant differences in survival. Using MaxStat, subdividing into two groups using 1.1 cm as the cut-off value, yielded significantly discrete prognostic groups (p < 0.001). CONCLUSION: The new T1 definition may be more practical, but the implications of the concept of "extension beyond the pancreas" should be re-investigated. Further, the subcategorization of T1a/b/c may not be adequate and may require revision or deletion.
Authors: Peter J Allen; Deborah Kuk; Carlos Fernandez-Del Castillo; Olca Basturk; Christopher L Wolfgang; John L Cameron; Keith D Lillemoe; Cristina R Ferrone; Vicente Morales-Oyarvide; Jin He; Matthew J Weiss; Ralph H Hruban; Mithat Gönen; David S Klimstra; Mari Mino-Kenudson Journal: Ann Surg Date: 2017-01 Impact factor: 12.969
Authors: N Volkan Adsay; Olca Basturk; Burcu Saka; Pelin Bagci; Denizhan Ozdemir; Serdar Balci; Juan M Sarmiento; David A Kooby; Charles Staley; Shishir K Maithel; Rhonda Everett; Jeanette D Cheng; Duangpeng Thirabanjasak; Donald W Weaver Journal: Am J Surg Pathol Date: 2014-04 Impact factor: 6.394
Authors: Oliver Strobel; Thomas Hank; Ulf Hinz; Frank Bergmann; Lutz Schneider; Christoph Springfeld; Dirk Jäger; Peter Schirmacher; Thilo Hackert; Markus W Büchler Journal: Ann Surg Date: 2017-03 Impact factor: 12.969