Research ArticleOriginal Article

Validation of the eighth edition of the AJCC staging system for patients with pancreatic adenocarcinoma initially receiving chemoradiotherapy and proposal of modifications

Xiaofei Zhu, Di Chen, Yangsen Cao, Xianzhi Zhao, Xiaoping Ju, Yuxin Shen, Fei Cao, Shuiwang Qing, Fang Fang, Zhen Jia and Huojun Zhang
Cancer Biology & Medicine May 2020, 17 (2) 492-500; DOI: https://doi.org/10.20892/j.issn.2095-3941.2019.0101

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    (A) Patient OS according to the seventh edition, (B) the T stage of the seventh edition for patients with negative lymph nodes, (C) the N stage of the seventh edition, (D) patient OS according to the eighth edition, (E) the T stage according to the eighth edition for patients with negative lymph nodes, and (F) the N stage according to the eighth edition.

  • Figure 2
    Figure 2

    (A) Patient OS in each substage classified according to the eighth edition and (B) the modified staging system.

  • Figure 3
    Figure 3

    (A) OS of the cohort from the SEER database according to the eighth edition and (B) the modified staging system, (C) ROC curves of the seventh and eighth editions, and the modified staging system at 1 year after treatment and (D) at 2 years after treatment.

Tables

  • Table 1

    Patient characteristics

    Characteristicsn (%)
    Number of patients683
    Age, years, median (range)66 (29–90)
    Gender
     Male409 (59.9%)
     Female174 (40.1%)
    Tumor diameter (cm), median (range)3.6 (0.6–9.0)
    TNM stage, seventh edition
     IA10 (1.5%)
     IB97 (14.2%)
     IIA141 (20.6%)
     IIB266 (38.9%)
     III169 (24.7%)
    TNM stage, eighth edition
     IA10 (1.5%)
     IB101 (14.8%)
     IIA137 (20.1%)
     IIB154 (22.5%)
     III281 (41.1%)
    Prescription dose (Gy), median (range)37 (32.5–49.6)/5-8f
    BED10 (Gy), median (range)61.92 (53.625–88.32)/5-8f
  • Table 2

    Survival outcomes according to the seventh and eighth edition staging systems

    Seventh editionPEighth editionP
    OS (95%CI)OS (95%CI)
    Cancer stageIA35.7 m (95%CI: 18.3–53.2 m)< 0.00135.7 m (95%CI: 18.3–53.2 m)< 0.001
    IB18.5 m (95%CI: 16.9–20.0 m)18.5 m (95%CI: 16.8–20.2 m)
    IIA15.4 m (95%CI: 14.8–16.0 m)15.5 m (95%CI: 14.6–16.4 m)
    IIB12.3 m (95%CI: 11.7–12.9 m)13.3 m (95%CI: 12.8–13.8 m)
    III7.5 m (95%CI: 6.6–8.4 m)8.9 m (95%CI: 8.2–9.6 m)
    T stage with N0T135.7 m (95%CI: 18.3–53.2 m)< 0.00135.7 m (95%CI: 18.3–53.2 m)< 0.001
    T218.5 m (95%CI: 16.9–20.0 m)18.5 m (95%CI: 16.8–20.2 m)
    T315.4 m (95%CI: 14.8–16.0 m)15.5 m (95%CI: 14.6–16.4 m)
    T49.1 m (95%CI: 8.6–9.6 m)9.1 m (95%CI: 8.6–9.6 m)
    N stageN015.4 m (95%CI: 14.4–16.4 m)< 0.00115.4 m (95%CI: 14.4–16.4 m)< 0.001
    N111.0 m (95%CI: 10.4–11.6 m)12.1 m (95%CI: 11.6–12.6 m)
    N2–10.1 m (95%CI: 9.4–10.8 m)
  • Table 3

    Survival comparisons of substages according to the eighth edition

    StageOS (95%CI)P
    IIB (T1-3N1)T1N1 vs. T2N120.9 m (95%CI: 17.5–24.3 m) vs. 15.1 m (95%CI: 14.3–15.9 m)0.011
    T1N1 vs. T3N120.9 m (95%CI: 17.5–24.3 m) vs. 12.3 m (95%CI: 11.6–13.0 m)< 0.001
    T2N1 vs. T3N115.1 m (95%CI: 14.3–15.9 m) vs. 12.3 m (95%CI: 11.6–13.0 m)< 0.001
    III (T1-3N2)T1N2 vs. T2N214.9 m (95%CI: 13.1–16.7 m) vs. 11.9 m (95%CI: 11.2–12.6 m)0.042
    T1N2 vs. T3N214.9 m (95%CI: 13.1–16.7 m) vs. 9.5 m (95%CI: 8.5–10.5 m)< 0.001
    T2N2 vs. T3N211.9 m (95%CI: 11.2–12.6 m) vs. 9.5 m (95%CI: 8.5–10.5 m)< 0.001
    III (T3N2, T4N1-2)T3N2 vs. T4N09.5 m (95%CI: 8.5–10.5 m) vs. 9.1 m (95%CI: 8.6–9.6 m)0.122
    T3N2 vs. T4N19.5 m (95%CI: 8.5–10.5 m) vs. 5.9 m (95%CI: 5.0–6.8 m)< 0.001
    T3N2 vs. T4N29.5 m (95%CI: 8.5–10.5 m) vs. 5.8 m (95%CI: 5.0–6.6 m)0.001
    T4N0 vs. T4N19.1 m (95%CI: 8.6–9.6 m) vs. 5.9 m (95%CI: 5.0–6.8 m)0.02
    T4N0 vs. T4N29.1 m (95%CI: 8.6–9.6 m) vs. 5.8 m (95%CI: 5.0–6.6 m)0.036
    –T1N1 (IIB) vs. T2N0 (IB)20.9 m (95%CI: 17.5–24.3 m) vs. 18.5 m (95%CI: 16.8–20.2 m)0.525
    –T2N2 (III) vs. T3N1 (IIB)11.9 m (95%CI: 11.2–12.6 m) vs. 12.3 m (95%CI: 11.6–13.0 m)0.897
    –T1N2 (III) vs. T2N1 (IIB)14.9 m (95%CI: 13.1–16.7 m) vs. 15.1 m (95%CI: 14.3–15.9 m)0.481
    –T1N2 (III) vs. T3N0 (IIA)14.9 m (95%CI: 13.1–16.7 m) vs. 15.5 m (95%CI: 14.6–16.4 m)0.210
    –T2N1 (IIB) vs. T3N0 (IIA)15.1 m (95%CI: 14.3–15.9 m) vs. 15.5 m (95%CI: 14.6–16.4 m)0.445
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