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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2016

01-06-2016 | Pancreatic Tumors

Pancreatic Ductal Adenocarcinoma is Spread to the Peripancreatic Soft Tissue in the Majority of Resected Cases, Rendering the AJCC T-Stage Protocol (7th Edition) Inapplicable and Insignificant: A Size-Based Staging System (pT1: ≤2, pT2: >2–≤4, pT3: >4 cm) is More Valid and Clinically Relevant

Authors: Burcu Saka, MD, Serdar Balci, MD, Olca Basturk, MD, Pelin Bagci, MD, Lauren M. Postlewait, MD, Shishir Maithel, MD, Jessica Knight, MPH, Bassel El-Rayes, MD, David Kooby, MD, Juan Sarmiento, MD, Takashi Muraki, MD, PhD, Irma Oliva, MD, Sudeshna Bandyopadhyay, MD, Gizem Akkas, MD, Michael Goodman, MD, PhD, Michelle D. Reid, MD, MS, Alyssa Krasinskas, MD, Rhonda Everett, MPH, MLIS, Volkan Adsay, MD

Published in: Annals of Surgical Oncology | Issue 6/2016

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Abstract

Background

Most studies have failed to identify any prognostic value of the current T-stage protocol for pancreatic ductal adenocarcinoma (PDAC) by the American Joint Committee on Cancer and the Union for International Cancer Control unless some grouping was performed.

Methods

To document the parameters included in this T-stage protocol, 223 consecutive pancreatoduodenectomy specimens with PDAC were processed by a uniform grossing protocol.

Results

Peripancreatic soft tissue (PST) involvement, the main pT3 parameter, was found to be inapplicable and irreproducible due to lack of a true capsule in the pancreas and variability in the amount and distribution of adipose tissue. Furthermore, 91 % of the cases showed carcinoma in the adipose tissue, presumably representing the PST, and thus were classified as pT3. An additional 4.5 % were qualified as pT3 due to extension into adjacent sites. The T-stage defined as such was not found to have any correlation with survival (p = 0.4). A revised T-stage protocol was devised that defined pT1 as 2 cm or smaller, pT2 as >2–4 cm, and pT3 as larger than 4 cm. This revised protocol was tested in 757 consecutive PDACs. The median and 3-year survival rates of this size-based protocol were 26, 18, 13 months, and 40 %, 26 %, 20 %, respectively (p < 0.0001). The association between higher T-stage and shorter survival persisted in N0 cases and in multivariate modeling. Analysis of the Surveillance, Epidemiology, and End Results database also confirmed the survival differences (p < 0.0001).

Conclusions

This study showed that resected PDACs are already spread to various surfaces of the pancreas, leaving only about 4 % of PDACs to truly qualify as pT1/T2, and that the current T-stage protocol does not have any prognostic correlation. In contrast, as shown previously in many studies, size is an important prognosticator, and a size-based T-stage protocol is more applicable and has prognostic value in PDAC.
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Metadata
Title
Pancreatic Ductal Adenocarcinoma is Spread to the Peripancreatic Soft Tissue in the Majority of Resected Cases, Rendering the AJCC T-Stage Protocol (7th Edition) Inapplicable and Insignificant: A Size-Based Staging System (pT1: ≤2, pT2: >2–≤4, pT3: >4 cm) is More Valid and Clinically Relevant
Authors
Burcu Saka, MD
Serdar Balci, MD
Olca Basturk, MD
Pelin Bagci, MD
Lauren M. Postlewait, MD
Shishir Maithel, MD
Jessica Knight, MPH
Bassel El-Rayes, MD
David Kooby, MD
Juan Sarmiento, MD
Takashi Muraki, MD, PhD
Irma Oliva, MD
Sudeshna Bandyopadhyay, MD
Gizem Akkas, MD
Michael Goodman, MD, PhD
Michelle D. Reid, MD, MS
Alyssa Krasinskas, MD
Rhonda Everett, MPH, MLIS
Volkan Adsay, MD
Publication date
01-06-2016
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2016
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5093-7

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