Features of T1 pancreatic cancer and validation of the eighth edition AJCC staging system definition using a Korean-Japanese joint cohort and the SEER database.
T1
extrapancreatic extension
pancreatic cancer
stage
subcategorization
Journal
Journal of hepato-biliary-pancreatic sciences
ISSN: 1868-6982
Titre abrégé: J Hepatobiliary Pancreat Sci
Pays: Japan
ID NLM: 101528587
Informations de publication
Date de publication:
Sep 2023
Sep 2023
Historique:
revised:
23
12
2022
received:
27
09
2022
accepted:
20
01
2023
medline:
14
9
2023
pubmed:
4
2
2023
entrez:
3
2
2023
Statut:
ppublish
Résumé
Little is known about the features of T1 pancreatic ductal adenocarcinoma (PDAC) and its definition in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system needs validation. The aims were to analyze the clinicopathologic features of T1 PDAC and investigate the validity of its definition. Data from 1506 patients with confirmed T1 PDAC between 2000 and 2019 were collected and analyzed. The results were validated using 3092 T1 PDAC patients from the Surveillance, Epidemiology, and End Results (SEER) database. The median survival duration of patients was 50 months, and the 5-year survival rate was 45.1%. R0 resection was unachievable in 10.0% of patients, the nodal metastasis rate was 40.0%, and recurrence occurred in 55.2%. The current T1 subcategorization was not feasible for PDAC, tumors with extrapancreatic extension (72.8%) had worse outcomes than those without extrapancreatic extension (median survival 107 vs. 39 months, p < .001). Extrapancreatic extension was an independent prognostic factor whereas the current T1 subcategorization was not. The results of this study were reproducible with data from the SEER database. Despite its small size, T1 PDAC displayed aggressive behavior warranting active local and systemic treatment. The subcategorization by the eighth edition of the AJCC staging system was not adequate for PDAC, and better subcategorization methods need to be explored. In addition, the role of extrapancreatic extension in the staging system should be reconsidered.
Sections du résumé
BACKGROUND/PURPOSE
OBJECTIVE
Little is known about the features of T1 pancreatic ductal adenocarcinoma (PDAC) and its definition in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system needs validation. The aims were to analyze the clinicopathologic features of T1 PDAC and investigate the validity of its definition.
METHOD
METHODS
Data from 1506 patients with confirmed T1 PDAC between 2000 and 2019 were collected and analyzed. The results were validated using 3092 T1 PDAC patients from the Surveillance, Epidemiology, and End Results (SEER) database.
RESULTS
RESULTS
The median survival duration of patients was 50 months, and the 5-year survival rate was 45.1%. R0 resection was unachievable in 10.0% of patients, the nodal metastasis rate was 40.0%, and recurrence occurred in 55.2%. The current T1 subcategorization was not feasible for PDAC, tumors with extrapancreatic extension (72.8%) had worse outcomes than those without extrapancreatic extension (median survival 107 vs. 39 months, p < .001). Extrapancreatic extension was an independent prognostic factor whereas the current T1 subcategorization was not. The results of this study were reproducible with data from the SEER database.
CONCLUSION
CONCLUSIONS
Despite its small size, T1 PDAC displayed aggressive behavior warranting active local and systemic treatment. The subcategorization by the eighth edition of the AJCC staging system was not adequate for PDAC, and better subcategorization methods need to be explored. In addition, the role of extrapancreatic extension in the staging system should be reconsidered.
Types de publication
Journal Article
Validation Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1129-1140Subventions
Organisme : Ministry of Science and ICT, South Korea
ID : NRF-2017M3C9A5031591
Informations de copyright
© 2023 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Références
Edge SB, American Joint Committee on Cancer. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.
Amin MB, American Joint Committee on Cancer., American Cancer Society. AJCC cancer staging manual. Eight edition/editor-in-chief, Mahul B. Amin, MD, FCAP ; editors, Stephen B. Edge, MD, FACS and 16 o0thers ; Donna M. Gress, RHIT, CTR - Technical editor ; Laura R. Meyer, CAPM - Managing editor. ed. Chicago IL: American Joint Committee on Cancer, Springer; 2017.
Kwon W, Park T, He J, Higuchi R, Son D, Lee SY, et al. Is the new T1 category as defined in the eighth edition of the AJCC pancreatic Cancer staging system an improvement? J Gastrointest Surg. 2020;24(2):262-9.
Kwon W, He J, Higuchi R, Son D, Lee SY, Kim J, et al. Multinational validation of the American joint Committee on Cancer 8th edition pancreatic cancer staging system in a pancreas head cancer cohort. J Hepatobiliary Pancreat Sci. 2018;25(9):418-27.
Adsay NV, Bagci P, Tajiri T, Oliva I, Ohike N, Balci S, et al. Pathologic staging of pancreatic, ampullary, biliary, and gallbladder cancers: pitfalls and practical limitations of the current AJCC/UICC TNM staging system and opportunities for improvement. Semin Diagn Pathol. 2012;29(3):127-41.
Saka B, Balci S, Basturk O, Bagci P, Postlewait LM, Maithel S, et al. Pancreatic ductal adenocarcinoma is spread to the Peripancreatic soft tissue in the majority of resected cases, rendering the AJCC T-stage protocol (7th edition) inapplicable and insignificant: a size-based staging system (pT1: </=2, pT2: >2-</=4, pT3: >4 cm) is more valid and clinically relevant. Ann Surg Oncol. 2016;23(6):2010-8.
Ozturk SK, Erden E. Do the well known prognostic parameters in pancreatic ductal adenocarcinoma really reflect survival? Turk Patoloji Derg. 2018;34(2):127-33.
Kim DW, Lee SS, Kim SO, Kim JH, Kim HJ, Byun JH, et al. Estimating recurrence after upfront surgery in patients with Resectable pancreatic ductal adenocarcinoma by using pancreatic CT: development and validation of a risk score. Radiology. 2020;296(3):541-51.
Lee HS, An C, Hwang HK, Roh YH, Kang H, Jo JH, et al. Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma. J Gastroenterol Hepatol. 2020;35(3):499-507.
Shah MM, NeMoyer RE, Greco SH, Chen C, Moore DF, Grandhi MS, et al. Subcategorizing T1 staging in pancreatic adenocarcinoma predicts survival in patients undergoing resection: An analysis of the National Cancer Database. J Pancreat Cancer. 2020;6(1):64-72.
Meng Z, Cao M, Zhang Y, Liu Z, Wu S, Wu H. Tumor location as an indicator of survival in T1 resectable pancreatic ductal adenocarcinoma: a propensity score-matched analysis. BMC Gastroenterol. 2019;19(1):59.
Kamarajah SK, Burns WR, Frankel TL, Cho CS, Nathan H. Validation of the American joint commission on Cancer (AJCC) 8th edition staging system for patients with pancreatic adenocarcinoma: a surveillance, epidemiology and end results (SEER) analysis. Ann Surg Oncol. 2017;24(7):2023-30.
van Roessel S, Kasumova GG, Verheij J, Najarian RM, Maggino L, de Pastena M, et al. International validation of the eighth edition of the American joint Committee on Cancer (AJCC) TNM staging system in patients with resected pancreatic Cancer. JAMA Surg. 2018;153(12):e183617.
Allen PJ, Kuk D, Castillo CF, Basturk O, Wolfgang CL, Cameron JL, et al. Multi-institutional validation study of the American joint commission on Cancer (8th edition) changes for T and N staging in patients with pancreatic adenocarcinoma. Ann Surg. 2017;265(1):185-91.