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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

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dc.contributor.authorBAĞCI ÇULÇİ, PELİN
dc.contributor.authorsSaka, Burcu; Balci, Serdar; Basturk, Olca; Bagci, Pelin; Postlewait, Lauren M.; Maithel, Shishir; Knight, Jessica; El-Rayes, Bassel; Kooby, David; Sarmiento, Juan; Muraki, Takashi; Oliva, Irma; Bandyopadhyay, Sudeshna; Akkas, Gizem; Goodman, Michael; Reid, Michelle D.; Krasinskas, Alyssa; Everett, Rhonda; Adsay, Volkan
dc.date.accessioned2022-03-14T08:15:28Z
dc.date.available2022-03-14T08:15:28Z
dc.date.issued2016-06
dc.description.abstractMost 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. To document the parameters included in this T-stage protocol, 223 consecutive pancreatoduodenectomy specimens with PDAC were processed by a uniform grossing protocol. 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). 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.
dc.identifier.doi10.1245/s10434-016-5093-7
dc.identifier.eissn1534-4681
dc.identifier.issn1068-9265
dc.identifier.pubmed26832882
dc.identifier.urihttps://hdl.handle.net/11424/241321
dc.identifier.wosWOS:000375613500034
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofANNALS OF SURGICAL ONCOLOGY
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectSINGLE-INSTITUTION EXPERIENCE
dc.subjectRANDOMIZED CONTROLLED-TRIAL
dc.subjectLONG-TERM SURVIVAL
dc.subjectLYMPH-NODE RATIO
dc.subjectCOMMON BILE-DUCT
dc.subjectPROGNOSTIC-FACTORS
dc.subjectPANCREATICODUODENECTOMY SPECIMENS
dc.subjectADJUVANT CHEMOTHERAPY
dc.subjectCURATIVE RESECTION
dc.subjectSURGICAL RESECTION
dc.titlePancreatic 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
dc.typearticle
dspace.entity.typePublication
local.avesis.id5526a91c-c627-4ede-9edf-5bf8625b7360
local.import.packageSS16
local.indexed.atWOS
local.indexed.atSCOPUS
local.indexed.atPUBMED
local.journal.numberofpages9
local.journal.quartileQ1
oaire.citation.endPage2018
oaire.citation.issue6
oaire.citation.startPage2010
oaire.citation.titleANNALS OF SURGICAL ONCOLOGY
oaire.citation.volume23
relation.isAuthorOfPublication08d32d97-3eab-4e66-9cb5-3177601d83e9
relation.isAuthorOfPublication.latestForDiscovery08d32d97-3eab-4e66-9cb5-3177601d83e9

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