Validation of American Joint Committee on Cancer 8th edition of TNM staging in resected distal pancreatic cancer

doi:10.4292/wjgpt.v11.i2.25

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World Journal of Gastrointestinal Pharmacology and Therapeutics

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Retrospective Cohort Study

World J Gastrointest Pharmacol Ther. Jun 9, 2020; 11(2): 25-39
Published online Jun 9, 2020. doi: 10.4292/wjgpt.v11.i2.25

Table 1 Clinical and pathological characteristics of pancreatic ductal adenocarcinoma patients

Feature	Level	Total cohort	Subcohort
Feature	Level	Total cohort	Invasive IPMN	Non-IPMN associated PDAC	P value
		Median (IQR)
Age (in yr)		67.6 (60.0, 74.8)	70.0 (64.1, 75.5)	66.7 (59.4, 74.0)	0.003
Tumor size (in cm)		3.5 (2.5, 5.0)	3.0 (2.0, 4.5)	3.6 (2.5, 5.2)	0.012
		Median (95%CI)
PFS (in mo)		21.0 (17.0, 27.0)	NR (47.0, NR)	17.0 (13.0, 22.0)	< 0.001
OS (in mo)		21.0 (19.0, 24.0)	60.0 (28.0, 69.0)	19.0 (18.0, 22.0)	< 0.001
		n (%)
Gender (male/female)	Female	243 (53.5)	61 (53.0)	182 (53.7)	0.991
Gender (male/female)	Male	211 (46.5)	54 (47.0)	157 (46.3)	0.991
Tumor differentiation	Well	41 (9.0)	15 (13.4)	26 (7.9)	0.103
	Moderate	271 (59.7)	71 (63.4)	200 (61.0)
	Poor	128 (28.2)	26 (23.2)	102 (31.1)
AJCC 8^th ed staging system	T1	76 (16.7)	32 (27.8)	44 (13.0)	0.003
	T2	202 (44.5)	46 (40.0)	156 (46.2)
	T3	166 (36.6)	36 (31.3)	130 (38.5)
AJCC 8^th ed staging system	N0	216 (47.6)	69 (60.0)	147 (43.4)	0.004
	N1	181 (39.9)	31 (27.0)	150 (44.2)
	N2	57 (12.6)	15 (13.0)	42 (12.4)
Lymphovascular invasion	Positive	219 (48.2)	44 (38.3)	175 (51.6)	0.011
	Negative	219 (48.2)	69 (60.0)	150 (44.2)
	Indetermi-nant	16 (3.5)	2 (1.7)	14 (4.1)
Perineural invasion	Positive	366 (80.6)	80 (69.6)	286 (84.4)	0.001
	Negative	82 (18.1)	34 (29.6)	48 (14.2)
	Indetermi-nant	6 (1.3)	1 (0.9)	5 (1.5)
Recurrence/metastasis	Present	218 (48.0)	43 (37.4)	175 (51.6)	0.015
Recurrence/metastasis	Absent	236 (52.0)	72 (62.6)	164 (48.4)	0.015
Splenic parenchymal invasion	Present	25 (5.5)	2 (1.7)	23 (6.9)	0.067
Splenic parenchymal invasion	Absent	425 (93.6)	113 (98.3)	312 (93.1)	0.067

AJCC: American Joint Committee on Cancer; IPMN: Intraductal papillary mucosal neoplasm; PDAC: Pancreatic ductal adenocarcinoma; PFS: Progression-free survival; OS: Overall survival; IQR: Interquartile range; NR: Not reached.

Table 2 Univariate and multivariable analysis for progression-free survival and overall survival in invasive intraductal papillary mucinous neoplasm

Feature	Level	PFS		OS
Feature	Level	HR (95%CI), P value
Gender		1.67 (0.91-3.05), P = 0.10	-	1.33 (0.85-2.08), P = 0.22	-
Age		0.99 (0.96-1.02), P = 0.52	-	1.01 (0.98-1.03), P = 0.54	-
Tumor size		1.18 (1.05-1.32), P = 0.01	-	1.10 (1.00-1.21), P = 0.04	-
Tumor differentiation	Well	-	-	-	-
	Moderate	2.71 (0.82-8.91), P = 0.10	12290265.82 (0.00-Inf), P = 1.00	1.04 (0.53-2.02), P = 0.92	1.62 (0.34-7.66), P = 0.55
	Poor	3.88 (1.06-14.27), P = 0.04	2274054.50 (0.00-Inf), P = 1.00	2.31 (1.10-4.86), P = 0.03	1.78 (0.15-20.67), P = 0.64
Positive lymph node		1.19 (1.05-1.35), P = 0.01	-	1.19 (1.07-1.31), P < 0.01	-
T stage (AJCC 8^th edition staging manual)	T1	-	-	-	-
	T2	2.69 (1.14-6.37), P = 0.02	0.81 (0.07-9.31), P = 0.87	1.65 (0.92-2.97), P = 0.09	0.89 (0.09-8.48), P = 0.92
	T3	3.48 (1.42-8.51), P = 0.01	5.29 (0.44-62.97), P = 0.19	2.28 (1.23-4.24), P = 0.01	26.22 (2.13-322.77), P = 0.01
N stage (AJCC 8^th edition staging manual)	N0	-	-	-	-
	N1	2.03 (1.03-4.02), P = 0.04	13.78 (1.15-165.63), P = 0.04	1.58 (0.93-2.67), P = 0.09	1.17 (0.24-5.70), P = 0.85
	N2	3.65 (1.60-8.34), P < 0.01	29.12 (0.87-979.78), P = 0.06	2.52 (1.36-4.65), P < 0.01	1.63 (0.10-27.11), P = 0.73
Lymphovascular invasion		2.12 (1.16-3.90), P = 0.02	0.31 (0.04-2.41), P = 0.26	1.43 (0.90-2.28), P = 0.13	-
Perineural invasion		1.99 (0.98-4.04), P = 0.06	-	2.45 (1.39-4.33), P < 0.01	2.67 (0.54-13.22), P = 0.23
Splenic artery invasion		5.30 (1.41-19.94), P = 0.01	2.44 (0.10-62.16), P = 0.59	1.70 (0.59-4.88), P = 0.32	-
Splenic vein invasion		18.69 (4.57-76.48), P < 0.01	5.28 (0.22-129.25), P = 0.31	2.66 (1.08-6.55), P = 0.03	5.62 (0.61-51.99), P = 0.13
Positive margin		1.25 (0.30-5.19), P = 0.76	-	3.14 (1.49-6.62), P < 0.01	0.00 (0.00-Inf), P = 1.00
Splenic parenchyma invasion		14.93 (1.83-121.81), P = 0.01	1.00 (1.00-1.00), P = NaN	1.23 (0.17-8.87), P = 0.84	-
Adjuvant radiation therapy		0.97 (0.52-1.81), P = 0.92	-	0.81 (0.48-1.37), P = 0.43	-
Adjuvant chemotherapy		2.50 (0.89-7.00), P = 0.08	-	0.69 (0.39-1.22), P = 0.20	-
Radiographic splenic artery invasion		2.12 (0.85-5.29), P = 0.11	-	1.45 (0.59-3.56), P = 0.41	-
Radiographic splenic vein invasion		2.27 (1.04-4.94), P = 0.04	2.88 (0.33-24.96), P = 0.34	1.46 (0.68-3.13), P = 0.33	-

AJCC: American Joint Committee on Cancer; PFS: Progression-free survival; OS: overall survival.

Table 3 Univariate and multivariable analysis for progression-free survival and overall survival in non-intraductal papillary mucinous neoplasm pancreatic ductal adenocarcinoma

Feature	Level	PFS		OS
Feature	Level	HR (95%CI), P value
Gender		0.89 (0.66-1.20), P = 0.43	-	1.05 (0.82-1.35), P = 0.69	-
Age		0.99 (0.98-1.01), P = 0.29	-	1.01 (1.00-1.03), P = 0.05	1.00 (0.98-1.02), P = 0.93
Tumor size		1.07 (0.99-1.15), P = 0.09	-	1.08 (1.02-1.16), P = 0.01	-
Tumor differentiation	Well	-	-	-	-
	Moderate	1.11 (0.64-1.91), P = 0.71	-	1.33 (0.78-2.27), P = 0.29	1.56 (0.65-3.78), P = 0.32
	Poor	1.21 (0.68-2.14), P = 0.52	-	1.72 (0.99-2.98), P = 0.05	2.23 (0.90-5.53), P = 0.08
Positive lymph node		1.06 (1.01-1.12), P = 0.03	-	1.08 (1.03-1.13), P < 0.01	-
T stage (AJCC 8^th edition staging manual)	T1	-	-	-	-
	T2	1.39 (0.83-2.31), P = 0.21	1.22 (0.73-2.05), P = 0.45	0.97 (0.64-1.46), P = 0.87	1.12 (0.57-2.20), P = 0.73
	T3	1.56 (0.92-2.62), P = 0.10	1.19 (0.68-2.07), P = 0.54	1.33 (0.88-2.03), P = 0.18	0.80 (0.39-1.64), P = 0.54
N stage (AJCC 8^th edition staging manual)	N0	-	-	-	-
	N1	1.73 (1.25-2.39), P < 0.01	1.59 (1.09-2.32), P = 0.02	1.75 (1.33-2.32), P < 0.01	2.54 (1.41-4.58), P < 0.01
	N2	1.57 (0.96-2.56), P = 0.07	1.47 (0.82-2.63), P = 0.20	1.83 (1.23-2.72), P < 0.01	2.45 (0.92-6.51), P = 0.07
Lymphovascular invasion		1.43 (1.05-1.95), P = 0.02	1.07 (0.73-1.56), P = 0.74	1.46 (1.12-1.89), P < 0.01	0.82 (0.45-1.49), P = 0.51
Perineural invasion		1.16 (0.76-1.78), P = 0.48	-	1.19 (0.83-1.73), P = 0.35	-
Splenic artery invasion		1.41 (0.71-2.80), P = 0.33	-	1.38 (0.81-2.36), P = 0.24	-
Splenic vein invasion		1.35 (0.82-2.23), P = 0.24	-	2.09 (1.44-3.03), P < 0.01	1.59 (0.83-3.02), P = 0.16
Positive margin		0.78 (0.43-1.40), P = 0.40	-	1.20 (0.78-1.82), P = 0.41	-
Splenic invasion		1.65 (0.95-2.85), P = 0.07	-	1.32 (0.82-2.11), P = 0.25	-
Adjuvant radiation therapy		0.93 (0.69-1.27), P = 0.66	-	0.85 (0.64-1.12), P = 0.25	-
Adjuvant chemotherapy		1.45 (0.90-2.34), P = 0.13	-	0.51 (0.37-0.71), P < 0.01	0.34 (0.20-0.58), P < 0.01
Radiographic splenic artery invasion		1.27 (0.87-1.84), P = 0.21	-	1.13 (0.81-1.59), P = 0.47	-
Radiographic splenic vein invasion		1.26 (0.88-1.80), P = 0.20	-	1.51 (1.10-2.07), P = 0.01	1.08 (0.65-1.80), P = 0.75

AJCC: American Joint Committee on Cancer; PFS: Progression-free survival; OS: Overall survival.

Citation: Yin F, Saad M, Xie H, Lin J, Jackson CR, Ren B, Lawson C, Karamchandani DM, Bernabeu BQ, Jiang W, Dhir T, Zheng R, Schultz CW, Zhang D, Thomas CL, Zhang X, Lai J, Schild M, Zhang X, Liu X. Validation of American Joint Committee on Cancer 8^th edition of TNM staging in resected distal pancreatic cancer. World J Gastrointest Pharmacol Ther 2020; 11(2): 25-39
URL: https://www.wjgnet.com/2150-5349/full/v11/i2/25.htm
DOI: https://dx.doi.org/10.4292/wjgpt.v11.i2.25