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Impact of Tumor Grade on Pancreatic Cancer Prognosis: Validation of a Novel TNMG Staging System

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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.

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.

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.

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Acknowledgment

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA

    Matthew M. Rochefort MD, Jacob S. Ankeny MD & James S. Tomlinson PhD, MD

  2. Department of Surgery, UCLA, Los Angeles, CA, USA

    Matthew M. Rochefort MD, Jacob S. Ankeny MD, Brian E. Kadera MD, Graham W. Donald MD, O. Joe Hines MD, Timothy R. Donahue MD, Howard A. Reber MD & James S. Tomlinson PhD, MD

  3. Department of Hematology and Oncology, UCLA, Los Angeles, CA, USA

    William Isacoff MD & Zev A. Wainberg MD

Authors
  1. Matthew M. Rochefort MD
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  2. Jacob S. Ankeny MD
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  3. Brian E. Kadera MD
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  4. Graham W. Donald MD
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  5. William Isacoff MD
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  6. Zev A. Wainberg MD
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  7. O. Joe Hines MD
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  8. Timothy R. Donahue MD
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  9. Howard A. Reber MD
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  10. James S. Tomlinson PhD, MD
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Corresponding author

Correspondence to James S. Tomlinson PhD, MD.

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Rochefort, M.M., Ankeny, J.S., Kadera, B.E. et al. Impact of Tumor Grade on Pancreatic Cancer Prognosis: Validation of a Novel TNMG Staging System. Ann Surg Oncol 20, 4322–4329 (2013). https://doi.org/10.1245/s10434-013-3159-3

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  • DOI: https://doi.org/10.1245/s10434-013-3159-3

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