Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2019 Dec 14;25(46):6752-6766. doi: 10.3748/wjg.v25.i46.6752.
The 8 edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC) excludes extrapancreatic extension from the assessment of T stage and restages tumors with mesenterico-portal vein (MPV) invasion into T1-3 diseases according to tumor size. However, MPV invasion is believed to be correlated with a poor prognosis.
To analyze whether the inclusion of MPV invasion can further improve the 8 edition of the AJCC staging system for PDAC.
This study retrospectively included 8 edition AJCC T1-3N0-2M0 patients undergoing pancreaticoduodenectomy/total pancreatectomy from two cohorts and analyzed survival outcomes. In the first cohort, a total of 7539 patients in the surveillance, epidemiology, and end results database was included, and in the second cohort, 689 patients from the West China Hospital database were enrolled.
Cox regression analysis showed that MPV invasion is an independent prognostic factor in both databases. In the MPV- group, all pairwise comparisons between the survival functions of patients with different stages were significant except for the comparison between patients with stage IIA and those with stage IIB. However, in the MPV+ group, pairwise comparisons between the survival functions of patients with stage IA, stage IB, stage IIA, stage IIB, and stage III were not significant. T1-3N0 patients in the MPV+ group were compared with the T1N0, T2N0, and T3N0 subgroups of the MPV- group; only the survival of MPV-T3N0 and MPV+T1-3N0 patients had no significant difference. Further comparisons of patients with stage IIA and subgroups of stage IIB showed (1) no significant difference between the survival of T2N1 and T3N0 patients; (2) a longer survival of T1N1 patients that was shorter than the survival of T2N0 patients; and (3) and a shorter survival of T3N1 patients that was similar to that of T1-3N2 patients.
The modified 8 edition of the AJCC staging system for PDAC proposed in this study, which includes the factor of MPV invasion, provides improvements in predicting prognosis, especially in MPV+ patients.
美国癌症联合委员会（AJCC）第 8 版胰腺癌（PDAC）分期系统将胰外延伸排除在 T 分期评估之外，并根据肿瘤大小将肠系膜门静脉（MPV）侵犯的肿瘤重新分期为 T1-3 期疾病。然而，MPV 侵犯被认为与预后不良相关。
分析是否纳入 MPV 侵犯可以进一步改善 PDAC 的第 8 版 AJCC 分期系统。
本研究回顾性纳入了来自两个队列接受胰十二指肠切除术/全胰切除术的第 8 版 AJCC T1-3N0-2M0 患者，并分析了生存结局。在第一队列中，纳入了监测、流行病学和最终结果数据库中的 7539 例患者，在第二队列中，纳入了华西医院数据库中的 689 例患者。
Cox 回归分析显示，在两个数据库中，MPV 侵犯都是独立的预后因素。在 MPV-组中，所有分期患者生存函数之间的两两比较均有统计学意义，除了 IIA 期和 IIB 期之间的比较。然而，在 MPV+组中，IA 期、IB 期、IIA 期、IIB 期和 III 期患者的生存函数之间的两两比较均无统计学意义。MPV+组的 T1-3N0 患者与 MPV-组的 T1N0、T2N0 和 T3N0 亚组进行比较；只有 MPV-T3N0 和 MPV+T1-3N0 患者的生存无显著差异。进一步比较 IIA 期和 IIB 期的亚组显示：（1）T2N1 患者与 T3N0 患者的生存无显著差异；（2）T1N1 患者的生存时间长于 T2N0 患者，但短于 T1N0 患者；（3）T3N1 患者的生存时间短于 T1-3N2 患者。
本研究提出的改良第 8 版 AJCC PDAC 分期系统纳入了 MPV 侵犯因素，提高了预后预测能力，特别是在 MPV+患者中。
