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

被引:218
作者
Kamarajah, Sivesh K. [1 ]
Burns, William R. [2 ]
Frankel, Timothy L. [2 ]
Cho, Clifford S. [2 ]
Nathan, Hari [2 ]
机构
[1] Univ Birmingham, Coll Med & Dent Sci, Birmingham, W Midlands, England
[2] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA
关键词
PROGNOSTIC-FACTORS; SURVIVAL; RESECTION; CHOLANGIOCARCINOMA; SURGERY; NUMBER; TRENDS; NODES;
D O I
10.1245/s10434-017-5810-x
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
The 8th edition of the AJCC staging system for pancreatic cancer incorporated several significant changes. This study sought to evaluate this staging system and assess its strengths and weaknesses relative to the 7th edition AJCC staging system. Using the Surveillance, Epidemiology and End Results (SEER) database (2004-2013), 8960 patients undergoing surgical resection for non-metastatic pancreatic adenocarcinoma were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-index) were calculated to evaluate the discriminatory power of both staging systems. The Cox proportional hazards model was used to determine the impact of T and N classification on overall survival. The c-index for the AJCC 8th staging system [0.60; 95% confidence interval (CI), 0.59-0.61] was comparable with that for the 7th edition AJCC staging system (0.59; 95% CI, 0.58-0.60). Stratified analyses for each N classification system demonstrated a diminishing impact of T classification on overall survival with increasing nodal involvement. The corresponding c-indices were 0.58 (95% CI, 0.55-0.60) for N0, 0.53 (95% CI, 0.51-0.55) for N1, and 0.53 (95% CI, 0.50-0.56) for N2 classification. This is the first large-scale validation of the AJCC 8th edition staging system for pancreatic cancer. The revised system provides discrimination similar to that of the 7th-edition system. However, the 8th-edition system allows for finer stratification of patients with resected tumors according to extent of nodal involvement.
引用
收藏
页码:2023 / 2030
页数:8
相关论文
共 27 条
[1]   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 [J].
Adsay, N. Volkan ;
Bagci, Pelin ;
Tajiri, Takuma ;
Oliva, Irma ;
Ohike, Nobuyuki ;
Balci, Serdar ;
Gonzalez, Raul S. ;
Basturk, Olca ;
Jang, Kee-Taek ;
Roa, Juan Carlos .
SEMINARS IN DIAGNOSTIC PATHOLOGY, 2012, 29 (03) :127-141
[2]   Multi-institutional Validation Study of the American Joint Commission on Cancer (8th Edition) Changes for Tand N Staging in Patients With Pancreatic Adenocarcinoma [J].
Allen, Peter J. ;
Kuk, Deborah ;
Fernandez-del Castillo, Carlos ;
Basturk, Olca ;
Wolfgang, Christopher L. ;
Cameron, John L. ;
Lillemoe, Keith D. ;
Ferrone, Cristina R. ;
Morales-Oyarvide, Vicente ;
He, Jin ;
Weiss, Matthew J. ;
Hruban, Ralph H. ;
Gonen, Mithat ;
Klimstra, David S. ;
Mino-Kenudson, Mari .
ANNALS OF SURGERY, 2017, 265 (01) :185-191
[3]   Prognostic factors analysis of 17,600 melanoma patients: Validation of the American Joint Committee on Cancer melanoma staging system [J].
Balch, CM ;
Soong, SJ ;
Gershenwald, JE ;
Thompson, JF ;
Reintgen, DS ;
Cascinelli, N ;
Urist, M ;
McMasters, KM ;
Ross, MI ;
Kirkwood, JM ;
Atkins, MB ;
Thompson, JA ;
Coit, DG ;
Byrd, D ;
Desmond, R ;
Zhang, YT ;
Liu, PY ;
Lyman, GH ;
Morabito, A .
JOURNAL OF CLINICAL ONCOLOGY, 2001, 19 (16) :3622-3634
[4]   Validation of the 6th Edition AJCC Pancreatic Cancer Staging System - Report from the National Cancer Database [J].
Bilimoria, Karl Y. ;
Bentrem, David J. ;
Ko, Clifford Y. ;
Ritchey, Jamie ;
Stewart, Andrew K. ;
Winchester, David P. ;
Talamonti, Mark S. .
CANCER, 2007, 110 (04) :738-744
[5]   Long-term survival after curative resection for pancreatic ductal adenocarcinoma - Clinicopathologic analysis of 5-year survivors [J].
Conlon, KC ;
Klimstra, DS ;
Brennan, MF .
ANNALS OF SURGERY, 1996, 223 (03) :273-279
[6]   Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment [J].
de Jong, Mechteld C. ;
Nathan, Hari ;
Sotiropoulos, Georgios C. ;
Paul, Andreas ;
Alexandrescu, Sorin ;
Marques, Hugo ;
Pulitano, Carlo ;
Barroso, Eduardo ;
Clary, Bryan M. ;
Aldrighetti, Luca ;
Ferrone, Cristina R. ;
Zhu, Andrew X. ;
Bauer, Todd W. ;
Walters, Dustin M. ;
Gamblin, T. Clark ;
Nguyen, Kevin T. ;
Turley, Ryan ;
Popescu, Irinel ;
Hubert, Catherine ;
Meyer, Stephanie ;
Schulick, Richard D. ;
Choti, Michael A. ;
Gigot, Jean-Francois ;
Mentha, Gilles ;
Pawlik, Timothy M. .
JOURNAL OF CLINICAL ONCOLOGY, 2011, 29 (23) :3140-3145
[7]   The American Joint Committee on Cancer: the 7th Edition of the AJCC Cancer Staging Manual and the Future of TNM [J].
Edge, Stephen B. ;
Compton, Carolyn C. .
ANNALS OF SURGICAL ONCOLOGY, 2010, 17 (06) :1471-1474
[8]   REGRESSION MODELING STRATEGIES FOR IMPROVED PROGNOSTIC PREDICTION [J].
HARRELL, FE ;
LEE, KL ;
CALIFF, RM ;
PRYOR, DB ;
ROSATI, RA .
STATISTICS IN MEDICINE, 1984, 3 (02) :143-152
[9]   Pancreatic Cancer Surgery in the New Millennium Better Prediction of Outcome [J].
Hartwig, Werner ;
Hackert, Thilo ;
Hinz, Ulf ;
Gluth, Alexander ;
Bergmann, Frank ;
Strobel, Oliver ;
Buechler, Markus W. ;
Werner, Jens .
ANNALS OF SURGERY, 2011, 254 (02) :311-319
[10]   Prognostic assessment of different lymph node staging methods for pancreatic cancer with R0 resection: pN staging, lymph node ratio, log odds-of positive lymph nodes [J].
La Torre, Marco ;
Nigri, Giuseppe ;
Petrucciani, Niccolo ;
Cavallini, Marco ;
Aurello, Paolo ;
Cosenza, Giulia ;
Balducci, Genoveffa ;
Ziparo, Vincenzo ;
Ramacciato, Giovanni .
PANCREATOLOGY, 2014, 14 (04) :289-294