Stage III should be subclassified into Stage IIIA and IIIB in the American Joint Committee on Cancer (8th Edition) staging system for pancreatic cancer

doi:10.3748/wjg.v24.i22.2400

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World Journal of Gastroenterology

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World J Gastroenterol. Jun 14, 2018; 24(22): 2400-2405
Published online Jun 14, 2018. doi: 10.3748/wjg.v24.i22.2400

Stage III should be subclassified into Stage IIIA and IIIB in the American Joint Committee on Cancer (8^th Edition) staging system for pancreatic cancer

Hai-Feng Yu, Bing-Qing Zhao, Yong-Cheng Li, Jun Fu, Wei Jiang, Rong-Wei Xu, Hao-Chang Yang, Xiao-Jun Zhang

Hai-Feng Yu, Wei Jiang, Department of General Surgery, Tianjin First Central Hospital, Tianjin 300192, China

Bing-Qing Zhao, Department of Surgery, Tianjin Second People’s Hospital, Tianjin 300192, China

Yong-Cheng Li, Department of Medical Oncology, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou 221009, Jiangsu Province, China

Jun Fu, Xiao-Jun Zhang, Department of Hepatic-Biliary-Pancreatic-Splenic Surgery, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou 221009, China

Rong-Wei Xu, Department of Vascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China

Hao-Chang Yang, College of Clinical Medicine, Binzhou Medical University, Yantai 264003, China

Author contributions: Yu HF and Zhang XJ designed the research and critically revised the manuscript for important intellectual content; all authors performed the research, analyzed the data, and wrote the paper.

Conflict-of-interest statement: All authors declare no competing financial interests.

Data sharing statement: No additional data are available.

Correspondence to: Xiao-Jun Zhang, MD, Doctor, Department of Hepatic Biliary Pancreatic Splenic Surgery, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, No.199 South Jiefang Road, Xuzhou 221009, Jiangsu Province, China. exiaojun@163.com.

Telephone: +86-18012018746

Received: March 19, 2018
Peer-review started: March 20, 2018
First decision: March 30, 2018
Revised: April 5, 2018
Accepted: May 5, 2018
Article in press: May 5, 2018
Published online: June 14, 2018
Processing time: 83 Days and 11.6 Hours

ARTICLE HIGHLIGHTS

Research background

The 8^th edition American Joint Committee on Cancer (AJCC) TNM staging system for pancreatic cancer has been applied in clinical practice since Jan 1 2018. The definition of stage III consists of TanyN2M0 and T4NanyM0. Our study aimed to evaluate the changes in the AJCC TNM system for defining stage III pancreatic cancer.

Research motivation

The 8^th edition AJCC TNM staging system for pancreatic cancer has just been applied in clinical practice for a short while and has not been validated yet. Hence, we used a population-based database to evaluate the rationality of the new staging system.

Research objectives

The primary purpose of this study was to examine the accuracy of classification of stage III. If there was some inadequacy, we would make necessary modifications in order to assure the precise staging.

Research methods

Patients were selected from the Surveillance Epidemiology and End Results database (2004-2013) and were divided into three groups: T(1-3)N2, T4N(0-1), and T4N2. Overall survival (OS) and disease-specific survival (DSS) of each group were evaluated by the Kaplan-Meier method.

Research results

A significant difference was observed in OS and DSS between T(1-3)N2/T4N(0-1) and T4N2 but not between T(1-3)N2 and T4N(0-1), which indicated stage III was a heterogeneous group. Additionally, a higher grading correlated with a worse prognosis in the T(1-3)N2 and T4N2 groups.

Research conclusions

Patients with stage T4N2 had a worse prognosis than those with stage T(1-3)N2/T4N(0-1) in the 8^th edition AJCC staging system for pancreatic cancer. Stage III should be subclassified into stage IIIA [T(1-3)N2/T4N(0-1)] and stage IIIB (T4N2), which will improve the staging system greatly.

Research perspectives

Larger sample sizes with prospective data should be provided to validate the modification in further research.