Abstract
In order to provide optimal cancer care and prognostication, it is necessary to stage the disease. The 8th edition of the TNM-staging for exocrine pancreatic ductal adenocarcinoma (PDAC) system has refined size-based T-stages and number-based N-categories. However, several impediments to the value of this may exist. For one, even at small size (e.g. <0.5 cm), PDACs readily metastasize, making size unreliable to predict behavior. The increasing shift towards neoadjuvant treatments for both resectable and borderline PDAC, and use of conversion therapy for locally advanced disease, suggest the need for additional biological predictors. Here we discuss whether recent changes in the TNM system for PDAC are along the lines of changes seen in contemporary management. Also, with the particular aggressive biology seen in PDAC, it is questioned whether the minute details in TNM refinement represents true progress or merely shuffles the cards.
Highlights
Despite progress achieved in recent years, the survival for pancreatic ductal adenocarcinoma (PDAC) remains poor; with a mere 7e9% true survivors 5 years after diagnosis
With the changes in management and the particular aggressive biology seen in PDAC, it is questioned whether such refinement represents true progress or merely shuffles the cards
The TNM system is the only universal staging system in use, but it has inherent limitations compared to other solid tumors, likely due to the particular tumor biology of PDAC
Summary
Refined TNM-staging for pancreatic adenocarcinoma e Real progress or much ado about nothing?. Article history: Received 6 January 2020 Received in revised form 11 February 2020 Accepted 16 February 2020 Available online 20 February 2020
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