Haihong Wang1, Zhenyu Lin1, Guiling Li1, Dejun Zhang1, Dandan Yu1, Qili Lin2, Jing Wang1, Ye Zhao1, Guoliang Pi3, Tao Zhang4. 1. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. 2. School of Business and Administration, Jiangxi University of Finance and Economics, Nanchang, China. 3. Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430079, China. 4. Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. taozhangxh@hust.edu.cn.
Abstract
BACKGROUND: The American Joint Committee on Cancer (AJCC) and the European Neuroendocrine Tumor Society (ENETS) staging classifications are two broadly used systems for pancreatic neuroendocrine tumors. This study aims to identify the most accurate and useful tumor-node-metastasis (TNM) staging system for poorly differentiated pancreatic neuroendocrine carcinomas (pNECs). METHODS: An analysis was performed to evaluate the application of the ENETS, 7th edition (7th) AJCC and 8th edition (8th) AJCC staging classifications using the Surveillance, Epidemiology, and End Results (SEER) registry (N = 568 patients), and a modified system based on the analysis of the 7th AJCC classification was proposed. RESULTS: In multivariable analyses, only the 7th AJCC staging system allocated patients into four different risk groups, although there was no significant difference. We modified the staging classification by maintaining the T and M definitions of the 7th AJCC staging and adopting new staging definitions. An increased hazard ratio (HR) of death was also observed from class I to class IV for the modified 7th (m7th) staging system (compared with stage I disease; HR for stage II =1.23, 95% confidence interval (CI) = 0.73-2.06, P = 0.44; HR for stage III =2.20, 95% CI =1.06-4.56, P = 0.03; HR for stage IV =4.95, 95% CI =3.20-7.65, P < 0.001). The concordance index (C-index) was higher for local disease with the m7th AJCC staging system than with the 7th AJCC staging system. CONCLUSIONS: The m7th AJCC staging system for pNECs proposed in this study provides improvements and may be assessed for potential adoption in the next edition.
BACKGROUND: The American Joint Committee on Cancer (AJCC) and the European Neuroendocrine Tumor Society (ENETS) staging classifications are two broadly used systems for pancreatic neuroendocrine tumors. This study aims to identify the most accurate and useful tumor-node-metastasis (TNM) staging system for poorly differentiated pancreatic neuroendocrine carcinomas (pNECs). METHODS: An analysis was performed to evaluate the application of the ENETS, 7th edition (7th) AJCC and 8th edition (8th) AJCC staging classifications using the Surveillance, Epidemiology, and End Results (SEER) registry (N = 568 patients), and a modified system based on the analysis of the 7th AJCC classification was proposed. RESULTS: In multivariable analyses, only the 7th AJCC staging system allocated patients into four different risk groups, although there was no significant difference. We modified the staging classification by maintaining the T and M definitions of the 7th AJCC staging and adopting new staging definitions. An increased hazard ratio (HR) of death was also observed from class I to class IV for the modified 7th (m7th) staging system (compared with stage I disease; HR for stage II =1.23, 95% confidence interval (CI) = 0.73-2.06, P = 0.44; HR for stage III =2.20, 95% CI =1.06-4.56, P = 0.03; HR for stage IV =4.95, 95% CI =3.20-7.65, P < 0.001). The concordance index (C-index) was higher for local disease with the m7th AJCC staging system than with the 7th AJCC staging system. CONCLUSIONS: The m7th AJCC staging system for pNECs proposed in this study provides improvements and may be assessed for potential adoption in the next edition.
Entities:
Keywords:
Neoplasm staging; Pancreatic neuroendocrine carcinoma; Poorly differentiated; SEER program
Authors: Anna La Salvia; Irene Persano; Elena Parlagreco; Alessandro Audisio; Massimiliano Cani; Maria Pia Brizzi Journal: Med Oncol Date: 2022-08-16 Impact factor: 3.738