Abstract
Background
The new T1 pancreatic cancer by the eighth edition of the AJCC staging system discards the concept of “extension beyond the pancreas” and focuses on size only. Furthermore, the new T1 is divided into T1a, T1b, and T1c based on size. The evidence pertaining to these changes has not been evaluated. This is to evaluate the feasibility of the new T1 definition in the pancreas head cancer cohort.
Methods
Data from 540 patients with T1 pancreatic ductal adenocarcinoma as defined by the eighth edition were collected from Korea, Japan, and the USA. Invasive IPMNs were excluded. Survival analyses were performed.
Results
Of the 540 patients, 181 patients were T1 according to the seventh edition and 359 were down-staged to T1 from the former T3 because the concept of “extension beyond the pancreas” was discarded. The 5-year survival rate and the median survival of T1 patients were 30.6% and 27 months, respectively. Comparing tumors that extend beyond the pancreas (new T1) and those confined within the pancreas (original T1), the latter showed significantly longer median survival (43 vs. 24 months, p < 0.001). In terms of T1a/b/c, there were no significant differences in survival. Using MaxStat, subdividing into two groups using 1.1 cm as the cut-off value, yielded significantly discrete prognostic groups (p < 0.001).
Conclusion
The new T1 definition may be more practical, but the implications of the concept of “extension beyond the pancreas” should be re-investigated. Further, the subcategorization of T1a/b/c may not be adequate and may require revision or deletion.
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Funding
This study was supported by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI16C2037).
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All authors made substantial contribution to the conception, design, interpretation, critical review, and final approval of this work. Wooil Kwon, Taesung Park, Jin He, Ryota Higuchi, Donghee Son, Seung Yeouun Lee, and Jin-Young Jang made extra contribution to data acquisition and analysis. Wooil Kwon, Donghee Son, and Jin-Young Jang contributed to the drafting of the work.
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Kwon, W., Park, T., He, J. et al. Is the New T1 Category as Defined in the Eighth Edition of the AJCC Pancreatic Cancer Staging System an Improvement?. J Gastrointest Surg 24, 262–269 (2020). https://doi.org/10.1007/s11605-019-04464-x
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DOI: https://doi.org/10.1007/s11605-019-04464-x