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. 2022 Sep 26;14(19):4672.
doi: 10.3390/cancers14194672.

Evaluation of the 8th Edition AJCC Staging System for the Clinical Staging of Pancreatic Cancer

Huapyong Kang  1   2 , Seung-Seob Kim  3 , Min Je Sung  4 , Jung Hyun Jo  5 , Hee Seung Lee  5 , Moon Jae Chung  5 , Jeong Youp Park  5 , Seung Woo Park  5 , Si Young Song  5 , Mi-Suk Park  3 , Seungmin Bang  5
Affiliations

Evaluation of the 8th Edition AJCC Staging System for the Clinical Staging of Pancreatic Cancer

Huapyong Kang et al. Cancers (Basel). .

Abstract

The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic cancer (PC) has been validated for pathological staging; however, its significance for clinical staging remains uncertain. We validated the prognostic performance and suitability of the current staging system for the clinical staging of PC. We identified 1043 patients from our PC registry who were staged by imaging according to the 8th edition staging system and conducted analysis, including overall survival (OS) comparison. Gradual prognostic stratification according to stage hierarchy yielded significant OS differences between stage groups, except between stage I and II (p = 0.193). A substage comparison revealed no survival differences between IB (T2N0) and IIA (T3N0), which were divided by the T3 criterion only (p = 0.278). A higher N stage had significantly shorter OS than a lower N stage (all pairwise p < 0.05). However, among the 150 patients who received upfront surgery, the pathological stage was more advanced than the clinical stage in 86 (57.3%), mostly due to a false-negative cN0 (70.9%). Our results suggest that the new definition of T3 and the number-based N criteria in the 8th edition AJCC staging system may be not adequate for clinical staging. Establishing separate criteria more suitable for clinical staging should be considered.

Keywords: adenocarcinoma; lymph node; neoplasm staging; pancreatic neoplasms; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier estimates of overall survival of stage groups according to the AJCC staging system, 8th edition. (A) Comparison of stages (from I to IV). (B) Comparison of substages (from IA to IIB).
Figure 1
Figure 1
Kaplan–Meier estimates of overall survival of stage groups according to the AJCC staging system, 8th edition. (A) Comparison of stages (from I to IV). (B) Comparison of substages (from IA to IIB).
Figure 2
Figure 2
Overall survival of non-metastatic pancreatic cancer patients according to the AJCC staging system, 8th edition, stratified by N staging.
See this image and copyright information in PMC

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