Department of Surgery, New York University Langone Health, New York, NY, USA.
Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center and St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Ann Surg Oncol. 2024 Dec;31(13):8712-8720. doi: 10.1245/s10434-024-16055-5. Epub 2024 Sep 16.
The American Joint Committee on Cancer (AJCC) eighth edition is based on pancreatic intraepithelial neoplasia-derived pancreatic ductal adenocarcinoma (PDAC), a biologically distinct entity from intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer. The role of nodal disease and the AJCC's prognostic utility for IPMN-derived pancreatic cancer are unclear. This study aimed to evaluate the prognostic role of nodal disease and the AJCC eighth-edition N-staging for IPMN-derived pancreatic cancer.
Upfront-surgery patients with IPMN-derived PDAC from four centers were stratified according to the AJCC eighth-edition N stage. Disease characteristics were compared using descriptive statistics, and both overall survival (OS) and recurrence-free survival (RFS) were evaluated using log-rank tests. Multivariable Cox regression was performed to determine the prognostic value of N stage for OS, presented as hazard ratios with 95 % confidence intervals (95 % CIs). A lowest p value log-rank statistic was used to derive the optimal cutoff for node-positive disease.
For 360 patients, advanced N stage was associated with worse T stage, grade, tubular histology, and perineural and lymphovascular invasion (all p < 0.05). The median OS was 98.3 months (95 % CI 82.8-122.0 months) for N0 disease, 27.8 months (95 % CI 24.4-41.7 months) for N1 disease, and 18.1 months (95 % CI 16.2-25.9 months) for N2 disease (p < 0.001). The AJCC N stage was validated and associated with worse OS (N1 [HR 1.64; range, 1.05-2.57], N2 [HR2.42; range, 1.48-3.96]) and RFS (N1 [HR 1.81; range, 1.23-2.68], N2 [HR 3.72; range, 2.40-5.77]). The optimal cutoff for positive nodes was five nodes.
The AJCC eighth-edition N-staging is valid and prognostic for both OS and RFS in IPMN-derived PDAC.
美国癌症联合委员会（AJCC）第八版是基于胰腺上皮内瘤变衍生的胰腺导管腺癌（PDAC），这是一种与导管内乳头状黏液性肿瘤（IPMN）衍生的胰腺癌在生物学上不同的实体。淋巴结疾病的作用和 AJCC 对 IPMN 衍生胰腺癌的预后作用尚不清楚。本研究旨在评估淋巴结疾病的预后作用和 AJCC 第八版 N 分期对 IPMN 衍生的胰腺导管腺癌的作用。
来自四个中心的 IPMN 衍生 PDAC 的术前手术患者根据 AJCC 第八版 N 期进行分层。使用描述性统计比较疾病特征，并使用对数秩检验评估总生存期（OS）和无复发生存期（RFS）。多变量 Cox 回归用于确定 N 期对 OS 的预后价值，表现为 95%置信区间（95%CI）的风险比。使用最低 p 值对数秩统计来确定阳性淋巴结疾病的最佳截止值。
对于 360 名患者，晚期 N 期与较差的 T 期、分级、管状组织学以及神经周围和血管侵犯相关（均 p<0.05）。N0 疾病的中位 OS 为 98.3 个月（95%CI 82.8-122.0 个月），N1 疾病为 27.8 个月（95%CI 24.4-41.7 个月），N2 疾病为 18.1 个月（95%CI 16.2-25.9 个月）（p<0.001）。AJCC N 期得到验证，并与较差的 OS（N1[HR 1.64；范围，1.05-2.57]，N2[HR 2.42；范围，1.48-3.96]）和 RFS（N1[HR 1.81；范围，1.23-2.68]，N2[HR 3.72；范围，2.40-5.77]）相关。阳性淋巴结的最佳截止值为 5 个淋巴结。
AJCC 第八版 N 分期对 IPMN 衍生的 PDAC 的 OS 和 RFS 均有效且具有预后意义。
