A New Staging System for Postoperative Prognostication in Pancreatic Ductal Adenocarcinoma

Overview

Journal iScience

Publisher Cell Press

Date 2023 Sep 4

PMID 37664604

Authors

Yuexiang Liang

Jingli Cui

Fanghui Ding

Yiping Zou

Hanhan Guo

Quan Man

Shaofei Chang

Song Gao

Jihui Hao

Affiliations

Soon will be listed here.

Abstract

The current TNM staging system for pancreatic ductal adenocarcinoma (PDAC) has revised the definitions of T and N categories as well as stage groups. However, studies validating these modifications have yielded inconsistent results. The existing TNM staging system in prognostic prediction remains unsatisfactory. The prognosis of PDAC is closely associated with pathological and biological factors. Herein, we propose a new staging system incorporating distant metastasis, postoperative serum levels of CA19-9 and CEA, tumor size, lymph node metastasis, lymphovascular involvement, and perineural invasion to enhance the accuracy of prognosis assessment. The proposed staging system exhibited a strong correlation with both overall survival and recurrence-free survival, effectively stratifying survival into five distinct tiers. Additionally, it had favorable discrimination and calibration. Thus, the proposed staging system demonstrates superior prognostic performance compared to the TNM staging system, and can serve as a valuable complementary tool to address the limitations of TNM staging in prognostication.

References

Yin F, Saad M, Xie H, Lin J, Jackson C, Ren B . Validation of American Joint Committee on Cancer 8 edition of TNM staging in resected distal pancreatic cancer. World J Gastrointest Pharmacol Ther. 2020; 11(2):25-39. PMC: 7288727. DOI: 10.4292/wjgpt.v11.i2.25. View

Regine W, Winter K, Abrams R, Safran H, Kessel I, Chen Y . Postresection CA19-9 and margin status as predictors of recurrence after adjuvant treatment for pancreatic carcinoma: Analysis of NRG oncology RTOG trial 9704. Adv Radiat Oncol. 2018; 3(2):154-162. PMC: 6000159. DOI: 10.1016/j.adro.2018.01.003. View

Shin D, Lee J, Kim J, Woo S, Lee W, Han S . Validation of the American Joint Committee on Cancer 8th edition staging system for the pancreatic ductal adenocarcinoma. Eur J Surg Oncol. 2019; 45(11):2159-2165. DOI: 10.1016/j.ejso.2019.06.002. View

Rapellino M, Piantino P, Pecchio F, Ruffini E, Cavallo A, Scappaticci E . Disappearance curves of tumor markers after radical surgery. Int J Biol Markers. 1994; 9(1):33-7. DOI: 10.1177/172460089400900107. View

Court C, Hines O . The New American Joint Committee on Cancer TNM Staging System for Pancreatic Cancer-Balancing Usefulness With Prognostication. JAMA Surg. 2018; 153(12):e183629. DOI: 10.1001/jamasurg.2018.3629. View

Kang J, Mok L, Heo J, Han I, Shin S, Yoon Y . Development and External Validation of Survival Prediction Model for Pancreatic Cancer Using Two Nationwide Databases: Surveillance, Epidemiology and End Results (SEER) and Korea Tumor Registry System-Biliary Pancreas (KOTUS-BP). Gut Liver. 2021; 15(6):912-921. PMC: 8593502. DOI: 10.5009/gnl20306. View

Xu H, Liu L, Xiang J, Wang W, Qi Z, Wu C . Postoperative serum CEA and CA125 levels are supplementary to perioperative CA19-9 levels in predicting operative outcomes of pancreatic ductal adenocarcinoma. Surgery. 2016; 161(2):373-384. DOI: 10.1016/j.surg.2016.08.005. View

Hu H, Qu C, Tang B, Liu W, Ma Y, Chen Y . Validation and modification of the AJCC 8th TNM staging system for pancreatic ductal adenocarcinoma in a Chinese cohort: A nationwide pancreas data center analysis. Chin J Cancer Res. 2021; 33(4):457-469. PMC: 8435826. DOI: 10.21147/j.issn.1000-9604.2021.04.03. View

Guo X, Gao S, Yu J, Zhou Y, Gao C, Hao J . The imaging features of extrapancreatic perineural invasion (EPNI) in pancreatic Cancer：A comparative retrospective study. Pancreatology. 2021; 21(8):1516-1523. DOI: 10.1016/j.pan.2021.08.010. View

10.

Epstein J, Kozak G, Fong Z, He J, Javed A, Joneja U . Microscopic lymphovascular invasion is an independent predictor of survival in resected pancreatic ductal adenocarcinoma. J Surg Oncol. 2017; 116(6):658-664. DOI: 10.1002/jso.24723. View

11.

Abdel-Rahman O . Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?. Hepatobiliary Pancreat Dis Int. 2018; 17(1):64-69. DOI: 10.1016/j.hbpd.2018.01.014. View

12.

Del Chiaro M, Rangelova E, Halimi A, Ateeb Z, Scandavini C, Valente R . Pancreatectomy with arterial resection is superior to palliation in patients with borderline resectable or locally advanced pancreatic cancer. HPB (Oxford). 2018; 21(2):219-225. DOI: 10.1016/j.hpb.2018.07.017. View

13.

Kamarajah S, Burns W, Frankel T, Cho C, 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):2023-2030. DOI: 10.1245/s10434-017-5810-x. View

14.

Huh J, Lee W, Shin J, Park Y, Cho Y, Kim H . A novel histologic grading system based on lymphovascular invasion, perineural invasion, and tumor budding in colorectal cancer. J Cancer Res Clin Oncol. 2019; 145(2):471-477. DOI: 10.1007/s00432-018-2804-4. View

15.

Park W, Chawla A, OReilly E . Pancreatic Cancer: A Review. JAMA. 2021; 326(9):851-862. PMC: 9363152. DOI: 10.1001/jama.2021.13027. View

16.

Hugenschmidt H, Labori K, Borgen E, Brunborg C, Schirmer C, Thomas Seeberg L . Preoperative CTC-Detection by CellSearch Is Associated with Early Distant Metastasis and Impaired Survival in Resected Pancreatic Cancer. Cancers (Basel). 2021; 13(3). PMC: 7865868. DOI: 10.3390/cancers13030485. View

17.

Liu L, Xu H, Wang W, Wu C, Chen Y, Yang J . A preoperative serum signature of CEA+/CA125+/CA19-9 ≥ 1000 U/mL indicates poor outcome to pancreatectomy for pancreatic cancer. Int J Cancer. 2014; 136(9):2216-27. DOI: 10.1002/ijc.29242. View

18.

Contreras C, Lin C, Oster R, Reddy S, Wang T, Vickers S . Increased pancreatic cancer survival with greater lymph node retrieval in the National Cancer Data Base. Am J Surg. 2017; 214(3):442-449. PMC: 5576522. DOI: 10.1016/j.amjsurg.2017.06.036. View

19.

Chun Y, Pawlik T, Vauthey J . 8th Edition of the AJCC Cancer Staging Manual: Pancreas and Hepatobiliary Cancers. Ann Surg Oncol. 2017; 25(4):845-847. DOI: 10.1245/s10434-017-6025-x. View

20.

Truty M, Kendrick M, Nagorney D, Smoot R, Cleary S, Graham R . Factors Predicting Response, Perioperative Outcomes, and Survival Following Total Neoadjuvant Therapy for Borderline/Locally Advanced Pancreatic Cancer. Ann Surg. 2019; 273(2):341-349. DOI: 10.1097/SLA.0000000000003284. View