The diversity between curatively resected pancreatic head and body-tail cancers based on the 8th edition of AJCC staging system: a multicenter cohort study

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background

To our knowledge, there are no studies to systematically compare the detailed clinical significance between curatively resected pancreatic head (ph) and body-tail (pbt) ductal adenocarcinoma based on the new 8th edition of AJCC staging system (8th AJCC stage) that was just applied in clinical practice in 2018.

Methods

Three hundred fifty-one patients with curatively resected pancreatic adenocarcinoma (PC) from three center hospitals were entered into this multicenter cohort study.

Results

Increasing tumor size ( P < 0.001), T stage (T1 + T2 vs T3 + T4, P = 0.003), frequent postoperative liver metastasis (PLM) ( P = 0.002) and 8th AJCC stage (IA to VI, P < 0.001; I + II vs III + IV, P = 0.002) were closely associated with the progression of pbt cancers compared with that in ph cancer patients. Moreover, tumor size≥3 cm ( P = 0.012), 8th AJCC stage (III + IV) ( P = 0.025) and PLM ( P = 0.010) were identified as independent risk factors in pbt cancers in logistic analysis. Patients with pbt cancers had a significantly worse overall survival compared with ph cancer patients ( P = 0.003). Moreover, pbt was an independent unfavorable factor in multivariate analysis ( P = 0.011). In addition to lymph nodes metastasis, 8th AJCC stage, vascular invasion and PLM, increasing tumor size and advanced T stage were also closely associated with the poor prognosis in 131 cases of pbt cancer patients compared with Ph cancer patients.

Conclusion

Pbt, as an independent unfavorable factor for the prognosis of PC patients, are much more aggressive than that in ph cancers according to 8th AJCC staging system. 8th AJCC staging system are more comprehensive and sensitive to reflect the malignant biology of pbt cancers.

Related collections

Most cited references 23

Record: found
Abstract: found
Article: not found

International Validation of the Eighth Edition of the American Joint Committee on Cancer (AJCC) TNM Staging System in Patients With Resected Pancreatic Cancer

Stijn van Roessel, Gyulnara Kasumova, Joanne Verheij … (2018)

Question What is the incremental value in prognostic accuracy of the American Joint Committee on Cancer eighth edition of the TNM staging system in resected pancreatic cancer, compared with the seventh edition? Findings In this cohort study of 1525 patients with resected pancreatic cancer from Europe and the United States, the eighth edition of the TNM staging system demonstrated a concordance statistic of 0.57, compared with 0.55 via the seventh edition. The revised T stage alone does not add to the discriminatory power, whereas the revised N stage is highly prognostic. Meaning The eighth edition of the TNM staging system provides additional prognostic accuracy in patients with resected pancreatic cancer compared with the seventh edition. This cohort study of patients in 4 European countries and the United States with resected pancreatic ductal adenocarcinoma assesses the validity of the eighth edition of the American Joint Committee on Cancer TNM staging system compared with the seventh edition. Importance The recently released eighth edition of the American Joint Committee on Cancer TNM staging system for pancreatic cancer seeks to improve prognostic accuracy but lacks international validation. Objective To validate the eighth edition of the American Joint Committee on Cancer TNM staging system in an international cohort of patients with resected pancreatic ductal adenocarcinoma. Design, Setting, and Participants This international multicenter cohort study took place in 5 tertiary centers in Europe and the United States from 2000 to 2015. Patients who underwent pancreatoduodenectomy for nonmetastatic pancreatic ductal adenocarcinoma were eligible. Data analysis took place from December 2017 to April 2018. Exposures Patients were retrospectively staged according to the seventh and eighth editions of the TNM staging system. Main Outcomes and Measures Prognostic accuracy on survival rates, assessed by Kaplan-Meier and multivariate Cox proportional hazards analyses and concordance statistics. Results A total of 1525 consecutive patients were included (median [IQR] age, 66 (58-72) years; 802 (52.6%) male). Distribution among stages via the seventh edition was stage IA in 41 patients (2.7%), stage IB in 42 (2.8%), stage IIA in 200 (13.1%), stage IIB in 1229 (80.6%), and stage III in 12 (0.8%); this changed with use of the eighth edition to stage IA in 118 patients (7.7%), stage IB in 144 (9.4%), stage IIA in 22 (1.4%), stage IIB in 643 (42.2%), and stage III in 598 (39.2%). With the eighth edition, 774 patients (50.8%) migrated to a different stage; 183 (12.0%) were reclassified to a lower stage and 591 (38.8%) to a higher stage. Median overall survival for the entire cohort was 24.4 months (95% CI, 23.4-26.2 months). On Kaplan-Meier analysis, 5-year survival rates changed from 38.2% for patients in stage IA, 34.7% in IB, 35.3% in IIA, 16.5% in IIB, and 0% in stage III (log-rank P < .001) via classification with the seventh edition to 39.2% for patients in stage IA, 33.9% in IB, 27.6% in IIA, 21.0% in IIB, and 10.8% in stage III (log-rank P < .001) with the eighth edition. For patients who were node negative, the T stage was not associated with prognostication of survival in either edition. In the eighth edition, the N stage was associated with 5-year survival rates of 35.6% in N0, 20.8% in N1, and 10.9% in N2 (log-rank P < .001). The C statistic improved from 0.55 (95% CI, 0.53-0.57) for the seventh edition to 0.57 (95% CI, 0.55-0.60) for the eighth edition. Conclusions and Relevance The eighth edition of the TNM staging system demonstrated a more equal distribution among stages and a modestly increased prognostic accuracy in patients with resected pancreatic ductal adenocarcinoma compared with the seventh edition. The revised T stage remains poorly associated with survival, whereas the revised N stage is highly prognostic.

0 comments Cited 92 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

The anatomic location of pancreatic cancer is a prognostic factor for survival.

Jiun Low, Avo Artinyan, Joshua D I Ellenhorn … (2007)

Pancreatic cancers of the body and tail (BT) appear to have poorer survival compared with head (HD) lesions. We hypothesized that potential disparities in outcome may be related to tumor location. Our objective was to examine the relationship between tumor location and survival. The Surveillance, Epidemiology, and End Results registry identified 33,752 patients with pancreatic adenocarcinoma and 6443 patients who underwent cancer-directed surgery between 1988 and 2004. Differences in survival and relationships between tumor location and clinical factors were assessed. Multivariate analysis was performed to determine the prognostic significance of tumor location. Median survival for the entire cohort was five months and was significantly lower for BT compared to HD lesions (four vs. six months, p<0.001). Distant metastases (67% vs. 36%, p<0.001) were greater and cancer-directed surgery (16% vs. 30%, p<0.001) was lower for BT tumors. Of 6443 resected patients, HD patients (n=5118) were younger, had a greater number of harvested lymph nodes, were more likely to be lymph node-positive, and had a higher proportion of T3/T4 lesions. Significant univariate predictors of survival included age, T-stage, number of positive and harvested lymph nodes. On multivariate analysis, BT location was a significant prognostic factor for decreased survival (OR 1.11, 95% CI 1.00-1.23, p=0.05). Pancreatic BT cancers have a lower rate of resectability and poorer overall survival compared to HD lesions. Prospective large-cohort studies may definitively prove that tumor location is a prognostic factor for survival in patients with pancreatic cancer.

0 comments Cited 81 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Incidence and survival of pancreatic head and body and tail cancers: a population-based study in the United States.

Yasser H. Shaib, Jessica A. Davila, Steven Lau (2010)

Cancer of the body/tail of the pancreas is frequently separated from pancreatic head tumors. No studies have examined whether the demographics, disease characteristics, and patient survival with pancreatic body/tail cancers are different from pancreatic head tumors. We used the Surveillance, Epidemiology, and End Results (SEER) registry to identify 43,946 cases of pancreatic cancer. The yearly incidence and survival rates were calculated. Cox proportional hazards model examined temporal trends in survival. The incidence rate for pancreatic head cancer has remained at 5.6% per 100,000, whereas the rate for pancreatic body/tail cancers has increased by 46% between 1973 and 2002. The 3-year survival rate has increased slightly for both groups. The Cox proportional hazards model analysis confirms this improvement. The 3-year survival rate for local-stage pancreatic body/tail cancer is 20.0% compared with 9% for local-stage pancreatic head cancer. This study indicates that the incidence of pancreatic head cancer has remained stable, whereas the incidence of pancreatic body/tail cancers is rising. Despite higher survival rates among patients with pancreatic head cancer compared with those with pancreatic body/tail cancers in several variables, patients with local-stage pancreatic body/tail cancers had higher survival rates compared with local-stage pancreatic head cancer.

0 comments Cited 69 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Ming Dong: +86-83282881 , cmudongming@sohu.com

Journal

Journal ID (nlm-ta): BMC Cancer

Journal ID (iso-abbrev): BMC Cancer

Title: BMC Cancer

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2407

Publication date (Electronic): 22 October 2019

Publication date PMC-release: 22 October 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 981

Affiliations

[1 ]ISNI 0000 0000 9678 1884, GRID grid.412449.e, Department of gastrointestinal surgery, the First Hospital, , China Medical University, ; Shenyang, 110001 China

[2 ]ISNI 0000 0000 9678 1884, GRID grid.412449.e, Department of general surgery, , Cancer hospital of China Medical University, ; Shenyang, 110042 China

[3 ]ISNI 0000 0004 1806 3501, GRID grid.412467.2, Department of thyroid and pancreatic surgery, , Shengjing Hospital of China Medical University, ; Shenyang, 110004 China

Article

Publisher ID: 6178

DOI: 10.1186/s12885-019-6178-z

PMC ID: 6805668

PubMed ID: 31640615

SO-VID: 168a48fe-ae99-4198-8634-77bb70d287ec

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 31 May 2019

Date accepted : 20 September 2019

Custom metadata

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: pancreatic head and body-tail cancers,clinical significance,prognosis,7th and 8th edition of ajcc staging system

Data availability:

ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: pancreatic head and body-tail cancers, clinical significance, prognosis, 7th and 8th edition of ajcc staging system

The diversity between curatively resected pancreatic head and body-tail cancers based on the 8th edition of AJCC staging system: a multicenter cohort study

Read this article at

Abstract

Background

Methods

Results

Conclusion

Related collections

Karger: Oncology

Most cited references 23

International Validation of the Eighth Edition of the American Joint Committee on Cancer (AJCC) TNM Staging System in Patients With Resected Pancreatic Cancer

The anatomic location of pancreatic cancer is a prognostic factor for survival.

Incidence and survival of pancreatic head and body and tail cancers: a population-based study in the United States.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Custom metadata

Comments

Comment on this article

Similar content 301

Cited by 9

Most referenced authors 698