Liang Yuexiang, Cui Jingli, Ding Fanghui, Zou Yiping, Guo Hanhan, Man Quan, Chang Shaofei, Gao Song, Hao Jihui
Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Tianjin 30060, China.
Department of Gastrointestinal Oncology Surgery, Center of Cancer Prevention and Therapy, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, China.
iScience. 2023 Aug 9;26(9):107589. doi: 10.1016/j.isci.2023.107589. eCollection 2023 Sep 15.
The current TNM staging system for pancreatic ductal adenocarcinoma (PDAC) has revised the definitions of T and N categories as well as stage groups. However, studies validating these modifications have yielded inconsistent results. The existing TNM staging system in prognostic prediction remains unsatisfactory. The prognosis of PDAC is closely associated with pathological and biological factors. Herein, we propose a new staging system incorporating distant metastasis, postoperative serum levels of CA19-9 and CEA, tumor size, lymph node metastasis, lymphovascular involvement, and perineural invasion to enhance the accuracy of prognosis assessment. The proposed staging system exhibited a strong correlation with both overall survival and recurrence-free survival, effectively stratifying survival into five distinct tiers. Additionally, it had favorable discrimination and calibration. Thus, the proposed staging system demonstrates superior prognostic performance compared to the TNM staging system, and can serve as a valuable complementary tool to address the limitations of TNM staging in prognostication.
目前用于胰腺导管腺癌（PDAC）的TNM分期系统已经修订了T和N类别的定义以及分期组。然而，验证这些修改的研究结果并不一致。现有的TNM分期系统在预后预测方面仍不尽人意。PDAC的预后与病理和生物学因素密切相关。在此，我们提出一种新的分期系统，纳入远处转移、术后血清CA19-9和CEA水平、肿瘤大小、淋巴结转移、淋巴管侵犯和神经周围侵犯，以提高预后评估的准确性。所提出的分期系统与总生存期和无复发生存期均有很强的相关性，有效地将生存期分为五个不同层次。此外，它具有良好的区分度和校准度。因此，所提出的分期系统与TNM分期系统相比，显示出更好的预后性能，并且可以作为一种有价值的补充工具，以解决TNM分期在预后判断方面的局限性。
