Cancer Res Treat.  2019 Oct;51(4):1639-1652. 10.4143/crt.2019.023.

Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database

• You Y
• Jang JY
• Kim SC
• Yoon YS
• Park JS
• Cho CK
• Park SJ
• Yang JD
• Lee WJ
• Hong TH
• Ahn KS
• Jeong CY
• Lee HK
• Lee SE
• Roh YH
• Kim HJ
• Kim H
• Han IW

• KMID: 2460612
• DOI: http://doi.org/10.4143/crt.2019.023

Abstract

PURPOSE
The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system.
MATERIALS AND METHODS
We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included.
RESULTS
Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS.
CONCLUSION
This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.

Keyword

Validation; Neoplasm staging; Pancreatic neuroendocrine tumor

MeSH Terms

Classification
Discrimination (Psychology)
Disease-Free Survival
Humans
Joints
Neoplasm Staging*
Neuroectodermal Tumors, Primitive
Neuroendocrine Tumors*
Pancreas*
Survival Rate

Figure

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  Fig. 1. Kaplan-Meier survival analysis of disease-free survival (DFS) according to T category of American Joint Committee on Cancer (AJCC) 7th edition (A), T category of AJCC 8th edition (B), 7th AJCC prognostic group (C), 8th AJCC prognostic group (D), European Neuroendocrine Tumors Society (ENETS) prognostic group (E), N category (F), 7th M category (G), 8th M category (H), and Grade (ENETS/World Health Organization [WHO] 2010) (I).

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  Fig. 2. Kaplan-Meier survival analysis of overall survival rate (OSR) according to T category of American Joint Committee on Cancer (AJCC) 7th edition (A), T category of AJCC 8th edition (B), 7th AJCC prognostic group (C), 8th AJCC prognostic group (D), European Neuroendocrine Tumors Society (ENETS) prognostic group (E), N category (F), 7th M category (G), 8th M category (H), and grade (ENETS/World Health Organization [WHO] 2010) (I).

Reference

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