The diversity between curatively resected pancreatic head and body-tail cancers based on the 8th edition of AJCC staging system: a multicenter cohort study

Weiwei Sheng,Wei Gao,Kewei Wang,Guosen Wang,Gang Shi,Ming Dong,Xiaodong Tan,He Song,Xiaoyang Shi

doi:10.1186/s12885-019-6178-z

Weiwei Sheng, Wei Gao + Show 7 more

Open Access

https://doi.org/10.1186/s12885-019-6178-z

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Abstract

BackgroundTo our knowledge, there are no studies to systematically compare the detailed clinical significance between curatively resected pancreatic head (ph) and body-tail (pbt) ductal adenocarcinoma based on the new 8th edition of AJCC staging system (8th AJCC stage) that was just applied in clinical practice in 2018.MethodsThree hundred fifty-one patients with curatively resected pancreatic adenocarcinoma (PC) from three center hospitals were entered into this multicenter cohort study.ResultsIncreasing tumor size (P < 0.001), T stage (T1 + T2 vs T3 + T4, P = 0.003), frequent postoperative liver metastasis (PLM) (P = 0.002) and 8th AJCC stage (IA to VI, P < 0.001; I + II vs III + IV, P = 0.002) were closely associated with the progression of pbt cancers compared with that in ph cancer patients. Moreover, tumor size≥3 cm (P = 0.012), 8th AJCC stage (III + IV) (P = 0.025) and PLM (P = 0.010) were identified as independent risk factors in pbt cancers in logistic analysis. Patients with pbt cancers had a significantly worse overall survival compared with ph cancer patients (P = 0.003). Moreover, pbt was an independent unfavorable factor in multivariate analysis (P = 0.011). In addition to lymph nodes metastasis, 8th AJCC stage, vascular invasion and PLM, increasing tumor size and advanced T stage were also closely associated with the poor prognosis in 131 cases of pbt cancer patients compared with Ph cancer patients.ConclusionPbt, as an independent unfavorable factor for the prognosis of PC patients, are much more aggressive than that in ph cancers according to 8th AJCC staging system. 8th AJCC staging system are more comprehensive and sensitive to reflect the malignant biology of pbt cancers.

Highlights

To our knowledge, there are no studies to systematically compare the detailed clinical significance between curatively resected pancreatic head and body-tail ductal adenocarcinoma based on the new 8th edition of AJCC staging system (8th AJCC stage) that was just applied in clinical practice in 2018
Comparison of the 7th and 8th editions of the TNM staging system for patients The detailed information of 7th and 8th AJCC stage in pancreatic adenocarcinoma (PC) was summarized in Additional file 1: Table S1 and Additional file 2: Table S2
Because all the patients enrolled in this study accept the curative resection, 6 PC patients with T4 stage (III stage) based on 8th AJCC stage were exclude in 7th AJCC system (Table 1)

Summary

Introduction

There are no studies to systematically compare the detailed clinical significance between curatively resected pancreatic head (ph) and body-tail (pbt) ductal adenocarcinoma based on the new 8th edition of AJCC staging system (8th AJCC stage) that was just applied in clinical practice in 2018. From 2000 to 2011, pancreatic adenocarcinoma (PC) takes up the second upward trend of age-standardized mortality rates in the Chinese male population [1] It is the fourth most common cause of cancer death in the United States and Japan [2, 3]. To the best of our knowledge, there is no studies to systematically compare the clinical significance between curatively resected ph and pbt cancers based on the new8th AJCC stage [8]. Based on the new 8th AJCC stage, we find new clinical difference between curatively resected ph and pbt cancers, which provides a new clinical sight in revealing the malignant biology of PC, especially in pbt cancer

Methods

Results

Conclusion