König Anna-Katharina, Gros Hélène, Hinz Ulf, Hank Thomas, Kaiser Jörg, Hackert Thilo, Bergmann Frank, Büchler Markus W, Strobel Oliver
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Pathology, University Hospital Heidelberg, Germany.
Eur J Surg Oncol. 2022 Jan;48(1):113-120. doi: 10.1016/j.ejso.2021.07.020. Epub 2021 Jul 26.
With changes in T and N categories the 8th edition of the AJCC/UICC TNM staging system for pancreatic cancer resulted in improved prognostic staging, but inconsistencies were observed with specific stage groups. Tumour grading remains disregarded in prognostic staging. We aimed to validate the current staging system and to investigate the possibility of further optimization by integration of grading.
1946 patients undergoing upfront surgical resection for pancreatic adenocarcinoma from 10/2001 to 12/2015 were identified from a prospective institutional database. Survival analyses based on the 8th UICC TNM edition were performed and rare TNM subgroups were reallocated based on survival. The impact of tumour grade on stage-specific survival was assessed and a TNMG staging system was developed.
The 8th UICC staging system accurately stratified prognosis except for comparable survival in stages IB (pT2N0M0) and IIA (pT3N0M0). Regrouping of pT3N0M0 and pT1N1M0 to IB and of pT1N2M0 to II resulted in a modified staging system with higher consistency. High tumour grade (G3&G4 vs G1&G2) was associated with a significantly shorter survival in all new stage groups except for stage IV modified UICC. A TNMG-based prognostic stage grouping in which high tumour grade results in grouping with tumours of the next higher pTNM-stage resulted in improvement of prognostication in non-metastatic pancreatic cancer.
The 8th edition of the UICC TNM staging system leaves room for improvement. A TNMG staging system with adjustments in group-allocation of specific rarely occurring pTNM subgroups and integration of tumour grade results in improved prognostic stratification.
随着T和N分类的变化，美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）胰腺癌TNM分期系统第8版在预后分期方面有所改进，但在特定分期组中观察到不一致之处。肿瘤分级在预后分期中仍未得到考虑。我们旨在验证当前的分期系统，并研究通过纳入分级进行进一步优化的可能性。
从一个前瞻性机构数据库中识别出2001年10月至2015年12月期间接受胰腺癌初次手术切除的1946例患者。基于第8版UICC TNM进行生存分析，并根据生存情况对罕见的TNM亚组进行重新分配。评估肿瘤分级对特定分期生存的影响，并开发了一个TNMG分期系统。
第8版UICC分期系统准确地对预后进行了分层，但IB期（pT2N0M0）和IIA期（pT3N0M0）的生存情况相当。将pT3N0M0和pT1N1M0重新分组为IB期，将pT1N2M0重新分组为II期，得到了一个一致性更高的改良分期系统。除了改良UICC IV期外，高肿瘤分级（G3和G4 vs G1和G2）在所有新分期组中均与显著较短的生存期相关。基于TNMG的预后分期分组，即高肿瘤分级导致与下一个更高pTNM分期的肿瘤归为一组，在非转移性胰腺癌中改善了预后评估。
UICC TNM分期系统第8版仍有改进空间。一个对特定罕见pTNM亚组的分组分配进行调整并纳入肿瘤分级的TNMG分期系统，可改善预后分层。
