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Impact of tumor grade on pancreatic cancer prognosis: validation of a novel TNMG staging system.

Authors :
Rochefort MM
Ankeny JS
Kadera BE
Donald GW
Isacoff W
Wainberg ZA
Hines OJ
Donahue TR
Reber HA
Tomlinson JS
Source :
Annals of surgical oncology [Ann Surg Oncol] 2013 Dec; Vol. 20 (13), pp. 4322-9. Date of Electronic Publication: 2013 Aug 14.
Publication Year :
2013

Abstract

Background: Pancreatic ductal adenocarcinoma (PDAC) patients demonstrate highly variable survival within each stage of the American Joint Committee on Cancer (AJCC) staging system. We hypothesize that tumor grade is partly responsible for this variation. Recently our group developed a novel tumor, node, metastasis, grade (TNMG) classification system utilizing Surveillance Epidemiology and End Results (SEER) data in which the presence of high tumor grade results in advancement to the next higher AJCC stage. This study's objective was to validate this TNMG staging system utilizing single-institution data.<br />Methods: All patients with PDAC who underwent resection at UCLA between 1990 and 2009 were identified. Clinicopathologic data reviewed included age, sex, node status, tumor size, grade, and stage. Grade was redefined as a dichotomous variable. The impact of grade on survival was assessed by Cox regression analysis. Disease was restaged into the TNMG system and compared to the AJCC staging system.<br />Results: We identified 256 patients who underwent resection for PDAC. Patients with low-grade tumors experienced a 13-month improvement in median survival compared to those with high-grade tumors. On multivariate analysis, tumor grade was the strongest predictor of survival with a hazard ratio of 2.02 (p = 0.0005). Restaging disease according to the novel TNMG staging system resulted in improved survival discrimination between stages compared to the current AJCC system.<br />Conclusions: We were able to demonstrate that grade is one of the strongest independent prognostic factors in PDAC. Restaging with our novel TNMG system demonstrated improved prognostication. This system offers an effective and convenient way of adding grade to the current AJCC staging system.

Details

Language :
English
ISSN :
1534-4681
Volume :
20
Issue :
13
Database :
MEDLINE
Journal :
Annals of surgical oncology
Publication Type :
Academic Journal
Accession number :
23943022
Full Text :
https://doi.org/10.1245/s10434-013-3159-3