Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma:A time to revisit a dogma?

摘要

Background: The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pan-creatic exocrine adenocarcinoma has been released. The current study seeks to assess the 7th and 8th editions among patients registered within the surveillance,epidemiology and end results(SEER)database. Methods: SEER database(2010–2013)has been accessed through SEER?Stat program and AJCC 8th edition stages were reconstructed utilizing the collaborative stage descriptions. Kaplan–Meier analysis of overall survival and pancreatic cancer-specific survival analyses (according to both 7th and 8th editions and ac-cording to whether pathological or clinical staging were conducted) has been performed. Multivariate analysis of factors affecting pancreatic cancer-specific survival was also conducted through a Cox propor-tional hazard model. Results: A total of 18 948 patients with pancreatic adenocarcinoma were identified in the period from 2010–2013. Pancreatic cancer-specific survival among pathologically staged patients and according to the 8th edition showed significant differences for all pair wise comparisons among different stages (P<0.0001) except for the comparison between stage IA and stage IB (P=0.307) and the comparison between stage IB and stage IIA (P=0.116). Moreover, P value for stage IA vs IIA was 0.014; while pan-creatic cancer-specific survival according to the 7th edition among pathologically staged patients showed significant differences for all pair wise comparisons among different stages (P<0.0001) except for the comparison between IA and IB(P=0.072),the comparison between stage IIA and stage IIB(P=0.065),the comparison between stage IIA and stage III(P=0.059)and the comparison between IIB and III(P=0.595). Among clinically staged patients (i.e. those who did not undergo initial radical surgery), the prognostic performance of both 7th and 8th stages for both overall survival and pancreatic cancer-specific survival was limited. Conclusion: There is clearly a need to have two staging systems for pancreatic adenocarcinoma: patho-logical and clinical staging systems.