Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
School of Business and Administration, Jiangxi University of Finance and Economics, Nanchang, China.
BMC Cancer. 2020 Mar 6;20(1):188. doi: 10.1186/s12885-020-6634-9.
The American Joint Committee on Cancer (AJCC) and the European Neuroendocrine Tumor Society (ENETS) staging classifications are two broadly used systems for pancreatic neuroendocrine tumors. This study aims to identify the most accurate and useful tumor-node-metastasis (TNM) staging system for poorly differentiated pancreatic neuroendocrine carcinomas (pNECs).
An analysis was performed to evaluate the application of the ENETS, 7th edition (7th) AJCC and 8th edition (8th) AJCC staging classifications using the Surveillance, Epidemiology, and End Results (SEER) registry (N = 568 patients), and a modified system based on the analysis of the 7th AJCC classification was proposed.
In multivariable analyses, only the 7th AJCC staging system allocated patients into four different risk groups, although there was no significant difference. We modified the staging classification by maintaining the T and M definitions of the 7th AJCC staging and adopting new staging definitions. An increased hazard ratio (HR) of death was also observed from class I to class IV for the modified 7th (m7th) staging system (compared with stage I disease; HR for stage II =1.23, 95% confidence interval (CI) = 0.73-2.06, P = 0.44; HR for stage III =2.20, 95% CI =1.06-4.56, P = 0.03; HR for stage IV =4.95, 95% CI =3.20-7.65, P < 0.001). The concordance index (C-index) was higher for local disease with the m7th AJCC staging system than with the 7th AJCC staging system.
The m7th AJCC staging system for pNECs proposed in this study provides improvements and may be assessed for potential adoption in the next edition.
美国癌症联合委员会（AJCC）和欧洲神经内分泌肿瘤学会（ENETS）分期分类是两种广泛用于胰腺神经内分泌肿瘤的系统。本研究旨在确定最准确和有用的用于低分化胰腺神经内分泌癌（pNEC）的肿瘤-淋巴结-转移（TNM）分期系统。
利用监测、流行病学和最终结果（SEER）登记处（N=568 例患者），对 ENETS、第 7 版（7 版）AJCC 和第 8 版（8 版）AJCC 分期分类的应用进行了分析，并提出了一种基于对 7 版 AJCC 分类分析的改良系统。
在多变量分析中，只有第 7 版 AJCC 分期系统将患者分为四个不同的风险组，尽管没有显著差异。我们通过保持 7 版 AJCC 分期的 T 和 M 定义，并采用新的分期定义来修改分期分类。改良的 7 版（m7 版）分期系统中，从 I 级到 IV 级，死亡的危险比（HR）也观察到增加（与 I 期疾病相比；II 期 HR=1.23，95%置信区间[CI]：0.73-2.06，P=0.44；III 期 HR=2.20，95%CI=1.06-4.56，P=0.03；IV 期 HR=4.95，95%CI=3.20-7.65，P<0.001）。与 7 版 AJCC 分期系统相比，m7 版 AJCC 分期系统用于局部疾病时的一致性指数（C 指数）更高。
本研究提出的用于 pNEC 的 m7 版 AJCC 分期系统有所改进，可能在下一版中进行评估。
