Abstract
BackgroundThe latest 8th edition of the AJCC staging system emphasizes the importance of tumor size however, the clinical significance of the combination of tumor location with tumor size remains unknown.MethodsWe conducted this study to investigate the prognostic role of tumor location in T1 resectable pancreatic ductal adenocarcinoma (PDAC). Resectable PDAC patients from Surveillance, Epidemiology, and End Results (SEER) database (2004–2014) were selected for the propensity score matching analysis. We used matched cohort to analyze the relationship between clinicopathologic features and survival of patients.ResultEight thousand, four hundred nine patients were included in the propensity score matching analysis and 4571 patients were selected for final analysis. In T1 patients, the patients with pancreatic head tumor had worse prognosis compared to the patients with body/tail tumors. Multivariate analysis result showed that pancreatic body/tail location was an independent indicator for better chances of survival in T1 PDAC patients (hazard ratio, 0.69; 95%CI, 0.52–0.93; P = 0.01). The modified staging system was more efficient than the AJCC 8th staging system.ConclusionModified staging system exhibited a good assessment of the survival rate. The tumor location is a good prognostic indicator for T1 resectable PDAC patients. Modification of T1 subgroup according to tumor location exhibited favorable survival prediction effects.
Highlights
The latest 8th edition of the the American Joint Committee on Cancer (AJCC) staging system emphasizes the importance of tumor size the clinical significance of the combination of tumor location with tumor size remains unknown
The aim of our study is to find out the influence of the tumor location on prognosis, and propose modifications for the 8th AJCC T-staging system in Pancreatic ductal adenocarcinoma (PDAC)
There was no significant correlation between tumor location and survival in patients with PDAC in T2 (p = 0.185) and T3 (p = 0.215) patients. These results showed that tumor location is associated with survival in patients with T1 PDAC
Summary
The latest 8th edition of the AJCC staging system emphasizes the importance of tumor size the clinical significance of the combination of tumor location with tumor size remains unknown. Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal disease. It has become the fourth-leading cause of cancer-related deaths and is projected to become the second leading cause of cancer-related deaths in the United States by 2030 [1, 2]. It is refractory to most treatment and exhibits a general 5-year survival rate of 8% [2, 3]. Surgical resection is the only potential treatment for PDAC patients [4]. It is important to assess the extent of tumor progression to determine the suitable surgical procedure.
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