Features of T1 pancreatic cancer and validation of the eighth edition AJCC staging system definition using a Korean-Japanese joint cohort and the SEER database
Features of T1 pancreatic cancer and validation of the eighth edition AJCC staging system definition using a Korean-Japanese joint cohort and the SEER database
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T1 胰腺癌的特征以及使用韩日联合队列和 SEER 数据库验证第八版 AJCC 分期系统定义
DOI：
10.1002/jhbp.1316
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Ja
中科院分区：
文献类型：
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作者：
Kwon W;Heo JS;Han IW;Kang CM;Hwang HK;Kim SC;Park SJ;Yoon YS;Kim YH;Lim CS;Lee SY;Park T;Takami H;Watanabe N;Shimizu Y;Okuno M;Yamaue H;Kawai M;Hirono S;Nagakawa Y;Osakabe H;Sugiura T;Toyama H;Ohtsuka M;Unno M;Endo I;Kitago M;Ja
背景/目的T1期胰腺导管腺癌（PDAC）的临床特征尚不清楚，美国癌症联合委员会（AJCC）第八版对PDAC的分期定义尚需进一步验证。目的分析T1 PDAC的临床病理特征，探讨其定义的有效性。方法收集2000 - 2019年1506例确诊的T1 PDAC患者的临床资料并进行分析。使用来自监测、流行病学和最终结果（SEER）database.ResultsThe患者的中位生存期为50个月，5年生存率为45.1%的3092 T1 PDAC患者的结果进行了验证。10.0%的患者无法实现R 0切除，淋巴结转移率为40.0%，复发率为55.2%。目前的T1亚分类对于PDAC是不可行的，有胰腺外转移的肿瘤（72.8%）比没有胰腺外转移的肿瘤预后更差（中位生存期107个月对39个月，p<0.001）。胰腺外侵犯是独立的预后因素，而目前的T1亚分类不是。这项研究的结果是可重复的数据从SEER database.ConclusionDespite其小尺寸，T1 PDAC显示积极的局部和全身治疗的积极行为。第八版AJCC分期系统的亚分类不足以用于PDAC，需要探索更好的亚分类方法。此外，胰腺外侵犯在分期系统中的作用应重新考虑。
Background/PurposeLittle is known about the features of T1 pancreatic ductal adenocarcinoma (PDAC) and its definition in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system needs validation. The aims were to analyze the clinicopathologic features of T1 PDAC and investigate the validity of its definition.MethodData from 1506 patients with confirmed T1 PDAC between 2000 and 2019 were collected and analyzed. The results were validated using 3092 T1 PDAC patients from the Surveillance, Epidemiology, and End Results (SEER) database.ResultsThe median survival duration of patients was 50 months, and the 5‐year survival rate was 45.1%. R0 resection was unachievable in 10.0% of patients, the nodal metastasis rate was 40.0%, and recurrence occurred in 55.2%. The current T1 subcategorization was not feasible for PDAC, tumors with extrapancreatic extension (72.8%) had worse outcomes than those without extrapancreatic extension (median survival 107 vs. 39 months,p< .001). Extrapancreatic extension was an independent prognostic factor whereas the current T1 subcategorization was not. The results of this study were reproducible with data from the SEER database.ConclusionDespite its small size, T1 PDAC displayed aggressive behavior warranting active local and systemic treatment. The subcategorization by the eighth edition of the AJCC staging system was not adequate for PDAC, and better subcategorization methods need to be explored. In addition, the role of extrapancreatic extension in the staging system should be reconsidered.