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Validation of the American Joint Commission on Cancer (AJCC) 8th Edition Staging System for Patients with Pancreatic Adenocarcinoma: A Surveillance, Epidemiology and End Results (SEER) Analysis

  • Hepatobiliary Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The 8th edition of the AJCC staging system for pancreatic cancer incorporated several significant changes. This study sought to evaluate this staging system and assess its strengths and weaknesses relative to the 7th edition AJCC staging system.

Methods

Using the Surveillance, Epidemiology and End Results (SEER) database (2004–2013), 8960 patients undergoing surgical resection for non-metastatic pancreatic adenocarcinoma were identified. Overall survival was estimated using the Kaplan–Meier method and compared using log-rank tests. Concordance indices (c-index) were calculated to evaluate the discriminatory power of both staging systems. The Cox proportional hazards model was used to determine the impact of T and N classification on overall survival.

Results

The c-index for the AJCC 8th staging system [0.60; 95% confidence interval (CI), 0.59–0.61] was comparable with that for the 7th edition AJCC staging system (0.59; 95% CI, 0.58–0.60). Stratified analyses for each N classification system demonstrated a diminishing impact of T classification on overall survival with increasing nodal involvement. The corresponding c-indices were 0.58 (95% CI, 0.55–0.60) for N0, 0.53 (95% CI, 0.51–0.55) for N1, and 0.53 (95% CI, 0.50–0.56) for N2 classification.

Conclusion

This is the first large-scale validation of the AJCC 8th edition staging system for pancreatic cancer. The revised system provides discrimination similar to that of the 7th-edition system. However, the 8th-edition system allows for finer stratification of patients with resected tumors according to extent of nodal involvement.

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Conflict of interest

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Author information

Authors and Affiliations

  1. College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

    Sivesh K. Kamarajah BMedSci

  2. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    William R. Burns MD, Timothy L. Frankel MD, Clifford S. Cho MD & Hari Nathan MD, PhD

Authors
  1. Sivesh K. Kamarajah BMedSci
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  2. William R. Burns MD
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  3. Timothy L. Frankel MD
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  4. Clifford S. Cho MD
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  5. Hari Nathan MD, PhD
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Corresponding author

Correspondence to Hari Nathan MD, PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10434_2017_5810_MOESM1_ESM.tif

Supplementary material 1 (TIFF 160 kb) Supplement 1: Overall survival of 8,960 patients who underwent resection for pancreatic adenocarcinoma (A) Overall survival by N classification according to AJCC 8th edition for all T classification

10434_2017_5810_MOESM2_ESM.tif

Supplementary material 2 (TIFF 155 kb) Supplement 1: Overall survival of 8,960 patients who underwent resection for pancreatic adenocarcinoma (B) Overall survival of N0 patients (AJCC 8th edition) stratified by T classification

10434_2017_5810_MOESM3_ESM.tif

Supplementary material 3 (TIFF 160 kb)Supplement 1: Overall survival of 8,960 patients who underwent resection for pancreatic adenocarcinoma (C) Overall survival of N1 patients (AJCC 8th edition) stratified by T classification

10434_2017_5810_MOESM4_ESM.tif

Supplementary material 4 (TIFF 158 kb) Supplement 1: Overall survival of 8,960 patients who underwent resection for pancreatic adenocarcinoma (D) Overall survival of N2 patients (AJCC 8th edition) stratified by T classification

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Kamarajah, S.K., Burns, W.R., Frankel, T.L. et al. Validation of the American Joint Commission on Cancer (AJCC) 8th Edition Staging System for Patients with Pancreatic Adenocarcinoma: A Surveillance, Epidemiology and End Results (SEER) Analysis. Ann Surg Oncol 24, 2023–2030 (2017). https://doi.org/10.1245/s10434-017-5810-x

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  • DOI: https://doi.org/10.1245/s10434-017-5810-x

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