Resectability of Pancreatic Cancer Is in the Eye of the Observer: A Multicenter, Blinded, Prospective Assessment of Interobserver Agreement on NCCN Resectability Status Criteria.
NCCN classification
interobserver agreement
pancreatic cancer
resectability
surgery
Journal
Annals of surgery open : perspectives of surgical history, education, and clinical approaches
ISSN: 2691-3593
Titre abrégé: Ann Surg Open
Pays: United States
ID NLM: 101769928
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
26
04
2021
accepted:
01
05
2021
medline:
11
8
2021
pubmed:
11
8
2021
entrez:
28
8
2023
Statut:
epublish
Résumé
To determine the reproducibility of the National Comprehensive Cancer Network (NCCN) resectability status classification for pancreatic cancer. The NCCN classification defines 3 resectability classes (resectable, borderline resectable, locally advanced), according to vascular invasion. It is used to recommend different approaches and stratify patients during clinical trials. Prospective, multicenter, observational study (trial ID: NCT03673423). Main outcome measure was the interobserver agreement of tumor assignment to different resectability classes and quantification of vascular invasion degrees. Agreement was measured by Fleiss' k (k = 1 perfect agreement; k = 0 agreement by chance). Sixty-nine computed tomography (CT) scans of pathologically confirmed pancreatic adenocarcinoma were independently reviewed in a blinded fashion by 22 observers from 11 hospitals (11 surgeons and 11 radiologists). Rating differences between surgeons or radiologists and between hospitals with different volumes (≥60 or <60 resections/year) were assessed. Complete agreement among 22 observers was recorded in 5 CT scans (7.2%), whereas 25 CT scans (36.2%) were variously assigned to all 3 resectability classes. Interobserver agreement varied from fair to moderate (Fleiss' k range: 0.282-0.555), with the lowest agreement for borderline resectable tumors. Assessing vascular contact ≤180° had the lowest agreement for all vessels (k range: 0.196-0.362). The highest concordance was recorded for venous invasion >180° (k range: 0.619-0.756). Neither reviewers' specialty nor hospital volume influenced the agreement. There is high variability in the assignment to resectability categories, which may compromise the reliability of treatments recommendations and the evidence of trials stratifying patients in resectability classes. Criteria should be revised to allow a reproducible classification.
Sections du résumé
Objectives
UNASSIGNED
To determine the reproducibility of the National Comprehensive Cancer Network (NCCN) resectability status classification for pancreatic cancer.
Background
UNASSIGNED
The NCCN classification defines 3 resectability classes (resectable, borderline resectable, locally advanced), according to vascular invasion. It is used to recommend different approaches and stratify patients during clinical trials.
Methods
UNASSIGNED
Prospective, multicenter, observational study (trial ID: NCT03673423). Main outcome measure was the interobserver agreement of tumor assignment to different resectability classes and quantification of vascular invasion degrees. Agreement was measured by Fleiss' k (k = 1 perfect agreement; k = 0 agreement by chance). Sixty-nine computed tomography (CT) scans of pathologically confirmed pancreatic adenocarcinoma were independently reviewed in a blinded fashion by 22 observers from 11 hospitals (11 surgeons and 11 radiologists). Rating differences between surgeons or radiologists and between hospitals with different volumes (≥60 or <60 resections/year) were assessed.
Results
UNASSIGNED
Complete agreement among 22 observers was recorded in 5 CT scans (7.2%), whereas 25 CT scans (36.2%) were variously assigned to all 3 resectability classes. Interobserver agreement varied from fair to moderate (Fleiss' k range: 0.282-0.555), with the lowest agreement for borderline resectable tumors. Assessing vascular contact ≤180° had the lowest agreement for all vessels (k range: 0.196-0.362). The highest concordance was recorded for venous invasion >180° (k range: 0.619-0.756). Neither reviewers' specialty nor hospital volume influenced the agreement.
Conclusions
UNASSIGNED
There is high variability in the assignment to resectability categories, which may compromise the reliability of treatments recommendations and the evidence of trials stratifying patients in resectability classes. Criteria should be revised to allow a reproducible classification.
Identifiants
pubmed: 37635813
doi: 10.1097/AS9.0000000000000087
pmc: PMC10455302
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e087Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
Disclosure: The authors declare that they have nothing to disclose.
Références
Ann Surg Oncol. 2006 Aug;13(8):1035-46
pubmed: 16865597
Radiology. 2014 Jan;270(1):248-60
pubmed: 24354378
Surgery. 2021 May;169(5):1026-1031
pubmed: 33036782
J Clin Oncol. 2020 Jun 1;38(16):1763-1773
pubmed: 32105518
J Natl Compr Canc Netw. 2019 Mar 1;17(3):202-210
pubmed: 30865919
JAMA Oncol. 2019 Jul 01;5(7):1020-1027
pubmed: 31145418
Cancers (Basel). 2020 Jun 24;12(6):
pubmed: 32599886
Ann Oncol. 2015 Sep;26 Suppl 5:v56-68
pubmed: 26314780
Br J Surg. 2020 Oct;107(11):1510-1519
pubmed: 32592514
J Clin Epidemiol. 2008 Apr;61(4):344-9
pubmed: 18313558
Br J Surg. 2017 Oct;104(11):1568-1577
pubmed: 28832964
Biometrics. 1977 Mar;33(1):159-74
pubmed: 843571
Gut. 2019 Jan;68(1):130-139
pubmed: 29158237
Ann Surg Oncol. 2013 Aug;20(8):2787-95
pubmed: 23435609
Radiology. 2019 Nov;293(2):343-349
pubmed: 31502935
BMC Cancer. 2019 Oct 22;19(1):979
pubmed: 31640628
Lancet Gastroenterol Hepatol. 2018 Jun;3(6):413-423
pubmed: 29625841
Updates Surg. 2021 Feb;73(1):233-249
pubmed: 32978753
HPB (Oxford). 2019 Feb;21(2):219-225
pubmed: 30093144
Ann Surg Oncol. 2009 Jul;16(7):1725-6
pubmed: 19396495