Ren Hu, Wu Chao-Rui, Qiu Guo-Tong, Zhang Li-Peng, Aimaiti Saderbieke, Wang Cheng-Feng
Department of Pancreatic and Gastric Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
J Oncol. 2020 Sep 21;2020:9093729. doi: 10.1155/2020/9093729. eCollection 2020.
The 8th American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC) outperforms its previous version in reproducibility but not in survival discrimination. Tumor grade, an indicator of the aggressive biology of PDAC, has been suggested as a reliable prognostic factor. This study aimed to construct a novel staging system with greater prognostication for resectable PDAC by incorporating tumor grade into the 8th AJCC system.
A total of 9966 patients with resectable PDAC from the Surveillance Epidemiology and End Results (SEER) database were randomly separated into training and interval validation sets. Another 324 patients from our center were included as an external validation set. We proposed a novel staging system by sorting the substages yielded by a combination of , , and tumor grade based on their overall survival (OS) and grouping them into several stages. Prognostic homogeneity and discrimination were determined using the likelihood ratio and the linear trend test, respectively. Prognostic accuracies were evaluated by the area under the receiver operating characteristics curve (AUC).
Using the 8th AJCC system, the prognosis of patients within the same stage was quite heterogeneous among different substages. The multivariate Cox model identified the tumor grade (hazard ratio 1.333, 95% confidence interval 1.250-1.423, < 0.001) was an independent prognostic factor of the OS. In the training set, the AUC, homogeneity, and discriminatory ability were superior for the novel staging system than for the 8th AJCC system (0.642 vs. 0.615, 403.4 vs. 248.6, and 335.1 vs. 218.0, respectively). Similar results were observed in the internal and external validation sets.
The novel staging system incorporating tumor grade into the 8th AJCC system was associated with better prognostic accuracy, homogeneity, and discriminatory ability among resectable PDAC patients. Moreover, the novel staging system also allowed possibly adjuvant chemotherapy decisions.
美国癌症联合委员会（AJCC）第八版胰腺导管腺癌（PDAC）分期系统在可重复性方面优于其先前版本，但在生存区分方面并非如此。肿瘤分级作为PDAC侵袭性生物学的一个指标，已被认为是一个可靠的预后因素。本研究旨在通过将肿瘤分级纳入第八版AJCC系统，构建一种对可切除PDAC具有更强预后能力的新型分期系统。
来自监测、流行病学和最终结果（SEER）数据库的9966例可切除PDAC患者被随机分为训练集和区间验证集。另外324例来自本中心的患者作为外部验证集。我们通过根据总生存期（OS）对由 、 和肿瘤分级组合产生的亚分期进行排序，并将它们分组为几个阶段，提出了一种新型分期系统。分别使用似然比 和线性趋势 检验来确定预后同质性和区分能力。通过受试者操作特征曲线（AUC）下的面积评估预后准确性。
使用第八版AJCC系统，同一分期内患者的预后在不同亚分期之间差异很大。多变量Cox模型确定肿瘤分级（风险比1.333，95%置信区间1.250 - 1.423， < 0.001）是OS的独立预后因素。在训练集中，新型分期系统的AUC、同质性和区分能力优于第八版AJCC系统（分别为0.642对0.615、403.4对248.6和335.对218.0）。在内部和外部验证集中也观察到了类似结果。
将肿瘤分级纳入第八版AJCC系统的新型分期系统在可切除PDAC患者中具有更好的预后准确性、同质性和区分能力。此外，新型分期系统还可能有助于辅助化疗决策。
