From the Departments of Pathology and Laboratory Medicine.
Surgery, and.
Pancreas. 2019 Aug;48(7):876-882. doi: 10.1097/MPA.0000000000001349.
Consistent and reliable tumor staging is a critical factor in determining treatment strategy, selection of patients for adjuvant therapy, and for therapeutic clinical trials. The aim of this study was to evaluate the number and extent of pancreatic ductal adenocarcinoma (PDAC) cases that would have a different pT, pN, and overall stages based on the new eighth edition American Joint Committee on Cancer staging system when compared with the seventh edition.
Patients diagnosed with PDAC who underwent pancreaticoduodenectomy, total pancreatectomy, or distal pancreatectomy from 2007 to 2017 were retrospectively reviewed. A total of 340 cases were included.
According to the seventh edition, the vast majority of tumors in our cohort were staged as pT3 tumors (88.2%). Restaging these cases with the new size-based pT system resulted in a more equal distribution among the 3 pT categories, with higher percentage of pT2 cases (55%).
The newly adopted pT stage protocol for PDAC is clinically relevant, ensures a more equal distribution among different stages, and allows for a significant prognostic stratification. In contrast, the new pN classification (pN1 and pN2) based on the number of positive lymph nodes failed to show survival differences and remains controversial.
肿瘤分期的一致性和可靠性是确定治疗策略、辅助治疗患者选择以及治疗性临床试验的关键因素。本研究旨在评估根据新的第八版美国癌症联合委员会（AJCC）分期系统，与第七版相比，有多少例胰腺导管腺癌（PDAC）病例的 pT、pN 和总体分期会有所不同。
回顾性分析了 2007 年至 2017 年间接受胰十二指肠切除术、全胰切除术或胰体尾切除术的 PDAC 患者。共纳入 340 例患者。
根据第七版，我们队列中的大多数肿瘤分期为 pT3 期（88.2%）。用新的基于大小的 pT 系统重新分期这些病例后，3 个 pT 分期之间的分布更加均匀，pT2 期的比例更高（55%）。
新采用的 PDAC pT 分期方案具有临床意义，可确保不同分期之间的分布更加均匀，并进行显著的预后分层。相比之下，新的基于阳性淋巴结数量的 pN 分类（pN1 和 pN2）未能显示出生存差异，仍存在争议。
