Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA.
Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann Diagn Pathol. 2020 Jun;46:151485. doi: 10.1016/j.anndiagpath.2020.151485. Epub 2020 Mar 6.
The 8th edition AJCC T stage criteria for pancreatic ductal adenocarcinoma (PDAC) are now size based. These criteria provide better prognostic stratification in patients without neoadjuvant therapy. Our aim was to determine if gross tumor size is prognostically significant using the 8th ed. staging criteria for neoadjuvant treated PDAC. The study included 289 patients who underwent resection for PDAC following neoadjuvant therapy. By AJCC 7th ed., there were 12 (4.2%) ypT0, 32 (11.1%) ypT1, 64 (22.1%) ypT2, and 181 (62.6%) ypT3 patients. By AJCC 8th ed., there were 12 (4.2%) ypT0, 74 (25.6%) ypT1 (6 ypT1a, 1 ypT1b, 67 ypT1c), 161 (55.7%) ypT2, and 42 (14.5%) ypT3 patients. 182 patients had negative lymph nodes and 107 had positive lymph nodes. 77 patients were ypN1 and 30 were ypN2 by 8th ed. criteria. 7th ed. T stage significantly correlated with OS (p = 0.048), while 8th ed. T stage did not correlate with OS (p = 0.13). In ypN0 patients, neither the 7th ed. or 8th ed. T stages significantly correlated with patient OS (p = 0.065 and 0.26, respectively). Higher 7th ed. T stage correlated with lymph node status (p ≤ 0.001) more strongly than 8th ed. T stage (p = 0.04). 7th ed. and 8th ed. N stage correlated with OS (p = 0.004 and p = 0.0002, respectively). By 8th ed. AJCC staging criteria, gross tumor size does not provide good prognostic stratification in neoadjuvant therapy PDAC. Mapped grossing techniques combining gross and microscopic examination to determine tumor size may provide more accurate staging of neoadjuvant treated tumors.
第 8 版 AJCC 胰腺导管腺癌 (PDAC) T 分期标准现在基于肿瘤大小。这些标准在未接受新辅助治疗的患者中提供了更好的预后分层。我们的目的是确定新辅助治疗后的 PDAC 是否使用第 8 版分期标准中的大体肿瘤大小具有预后意义。该研究纳入了 289 例接受新辅助治疗后行切除术的 PDAC 患者。根据 AJCC 第 7 版分期标准，有 12 例（4.2%）ypT0，32 例（11.1%）ypT1，64 例（22.1%）ypT2 和 181 例（62.6%）ypT3 患者。根据 AJCC 第 8 版分期标准，有 12 例（4.2%）ypT0，74 例（25.6%）ypT1（6 例 ypT1a，1 例 ypT1b，67 例 ypT1c），161 例（55.7%）ypT2 和 42 例（14.5%）ypT3 患者。182 例患者淋巴结阴性，107 例患者淋巴结阳性。77 例患者为 ypN1，30 例患者为 ypN2。第 7 版 T 分期与 OS 显著相关（p=0.048），而第 8 版 T 分期与 OS 无相关性（p=0.13）。在 ypN0 患者中，第 7 版和第 8 版 T 分期均与患者 OS 无相关性（p=0.065 和 0.26）。第 7 版 T 分期与淋巴结状态的相关性强于第 8 版 T 分期（p≤0.001）（p=0.04）。第 7 版和第 8 版 N 分期与 OS 相关（p=0.004 和 p=0.0002）。根据第 8 版 AJCC 分期标准，大体肿瘤大小在新辅助治疗的 PDAC 中不能提供良好的预后分层。结合大体和显微镜检查来确定肿瘤大小的大体标本制作技术可能为新辅助治疗的肿瘤提供更准确的分期。
