scholarly journals Equipping the American Joint Committee on Cancer Staging for Resectable Pancreatic Ductal Adenocarcinoma with Tumor Grade: A Novel Staging System

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Hu Ren ◽  
Chao-Rui Wu ◽  
Guo-Tong Qiu ◽  
Li-Peng Zhang ◽  
Saderbieke Aimaiti ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Pancreatic Ductal Adenocarcinoma ◽  
External Validation ◽  
Staging System ◽  
Tumor Grade ◽  
Ductal Adenocarcinoma ◽  
The Novel ◽  
Operating Characteristics ◽  
Discriminatory Ability ◽  
American Joint Committee

Background. The 8th American Joint Committee on Cancer (AJCC) staging system for pancreatic ductal adenocarcinoma (PDAC) outperforms its previous version in reproducibility but not in survival discrimination. Tumor grade, an indicator of the aggressive biology of PDAC, has been suggested as a reliable prognostic factor. This study aimed to construct a novel staging system with greater prognostication for resectable PDAC by incorporating tumor grade into the 8th AJCC system. Methods. A total of 9966 patients with resectable PDAC from the Surveillance Epidemiology and End Results (SEER) database were randomly separated into training and interval validation sets. Another 324 patients from our center were included as an external validation set. We proposed a novel staging system by sorting the substages yielded by a combination of T, N, and tumor grade based on their overall survival (OS) and grouping them into several stages. Prognostic homogeneity and discrimination were determined using the likelihood ratio χ2 and the linear trend χ2 test, respectively. Prognostic accuracies were evaluated by the area under the receiver operating characteristics curve (AUC). Results. Using the 8th AJCC system, the prognosis of patients within the same stage was quite heterogeneous among different substages. The multivariate Cox model identified the tumor grade (hazard ratio 1.333, 95% confidence interval 1.250–1.423, p<0.001) was an independent prognostic factor of the OS. In the training set, the AUC, homogeneity, and discriminatory ability were superior for the novel staging system than for the 8th AJCC system (0.642 vs. 0.615, 403.4 vs. 248.6, and 335.1 vs. 218.0, respectively). Similar results were observed in the internal and external validation sets. Conclusions. The novel staging system incorporating tumor grade into the 8th AJCC system was associated with better prognostic accuracy, homogeneity, and discriminatory ability among resectable PDAC patients. Moreover, the novel staging system also allowed possibly adjuvant chemotherapy decisions.

Validation of the American Joint Committee on Cancer 8th edition staging system for the pancreatic ductal adenocarcinoma

2019 ◽  
Vol 45 (11) ◽  
pp. 2159-2165 ◽  
Author(s):  
Dong Woo Shin ◽  
Jong-chan Lee ◽  
Jaihwan Kim ◽  
Sang Myung Woo ◽  
Woo Jin Lee ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Staging System ◽  
Ductal Adenocarcinoma ◽  
American Joint Committee ◽  
8Th Edition

scholarly journals Identification of a robust functional subpathway signature for pancreatic ductal adenocarcinoma by comprehensive and integrated analyses

2019 ◽  
Author(s):  
Ping Wang ◽  
Chunlong Zhang ◽  
Weidong Li ◽  
Bo Zhai ◽  
Xian Jiang ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Drug Response ◽  
Staging System ◽  
Tnm Staging ◽  
Ductal Adenocarcinoma ◽  
The Novel ◽  
Gene Signatures ◽  
Tnm Staging System ◽  
Meta Analyses ◽  
Microarray Expression

Abstract Background: Pancreatic ductal adenocarcinoma (PDAC) is a highly lethal malignancy and its mortality continues to rise globally. Because of its high heterogeneity and complex molecular landscapes, published gene signatures have shown low specificity and robustness. Functional signatures containing a group of genes involved in similar biological functions display a more robust performance. Methods: The present study was designed to excavate potential functional signatures for PDAC by analyzing maximal number of datasets extracted from available databases with a recently developed method of FAIME (Functional Analysis of Individual Microarray Expression) in a comprehensive and integrated way. Results: By using appropriate search strategies, we extracted 11 PDAC datasets from GEO, ICGC and TCGA databases. By systemically analyzing these datasets, we identified a robust functional signature of subpathway (path:00982_1), which belongs to the drug metabolism-cytochrome P450 pathway. The functional signature has displayed a more powerful and robust capacity in predicting prognosis, drug response and chemotherapeutic efficacy for PDAC, particularly for the classical subtype, in comparison with published gene signatures and clinically used TNM staging system. This signature was further verified by meta-analyses and validated in cell line databases and available clinical datasets. Conclusion: This is the first functional signature for PDAC identified from the largest number of datasets by using comprehensive and integrated analyses. The novel signature warrants a further investigation, since it is like to improve the current systems for predicting the prognosis and monitoring drug response, and to serve a potential linkage to therapeutic options for combating PDAC.

scholarly journals HMGA1 correlates with advanced tumor grade and decreased survival in pancreatic ductal adenocarcinoma

2009 ◽  
Vol 23 (1) ◽  
pp. 98-104 ◽  
Author(s):  
Alexandra C Hristov ◽  
Leslie Cope ◽  
Francescopaolo Di Cello ◽  
Marcelo Delos Reyes ◽  
Mansher Singh ◽  
...  
Keyword(s):  
Pancreatic Ductal Adenocarcinoma ◽  
Tumor Grade ◽  
Ductal Adenocarcinoma ◽  
Advanced Tumor

A new staging system for radiotherapy-based treatment of hepatocellular carcinoma: A multicenter cohort study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e16155-e16155
Author(s):  
Ting-Shi Su ◽  
Shi-Xiong Liang ◽  
Li-Qing Li ◽  
Qiu-Hua Liu ◽  
Xiao-Fei Zhu ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
External Validation ◽  
Staging System ◽  
Time Dependent ◽  
Multicenter Cohort Study ◽  
Discriminatory Ability ◽  
Training Cohort ◽  
Multicenter Cohort ◽  
Staging Systems

e16155 Background: External beam radiation therapy has been used as a palliative to radical treatment of hepatocellular carcinoma (HCC) depending on different tumor status, liver function and patient's general state of health. The existing models of HCC staging cannot perfectly predict the prognosis of radiotherapy. In this study, we aimed to set up a new staging system for radiotherapy-based treatment by incorporating bilirubin-albumin (ALBI) grade and tumor status for the prognostic classifications of HCC. Methods: This multicenter cohort study included 878 HCC patients who received radiotherapy-based treatment. A new staging system was established: stage I, solitary nodule without macrovascular invasion or 2-3 nodules with no more than 3.0 cm each other and PS 0-2 (Ia: ALBI-1 grade; Ib: ALBI-2 or 3 grade); stage II: 2-3 nodules with anyone more than 3.0 cm or ≥4 nodules and PS 0-2 (IIa: ALBI-1 grade; IIb: ALBI-2 grade); stage III: macrovascular invasion or regional lymph node metastasis or distant metastasis and PS 0-2 (IIIa: ALBI-1 grade; IIIb:ALBI-2 grade); stage IV: ALBI-3 grade without stage I patient or/and PS score 3-4. The new modified staging system and the existing staging systems, such as the BCLC, TNM, CNLC staging systems were used for prognostic analysis. All patients were separated into different stages and substages. The long-term overall survival outcomes and time-dependent receiver operating characteristic (ROC) were analyzed. Results: A training cohort of 595 patients underwent stereotactic body radiotherapy (SBRT) from 2011 to 2017 and an external validation cohort of 283 patients underwent intensity-modulated radiotherapy (IMRT) from 2000 to 2013 were included into establishing and validating the new staging system. In the training cohort, the median follow-up time was 55 months (range, 6–100 months), and the new staging system had a good discriminatory ability to separate patients into different stages with 4 notably different curves and substages with 7 notably different curves. BCLC staging could not differentiate stage 0 to A, and stage C to D in these selected patients. TNM staging could not completely distinguish stage IIIb to IV, but also stage Ia to Ib. CNLC staging could not differentiate among stage IIIa, IIIb, and IV. In the external validation, the median follow-up time was 95 months (range, 9–120 months), and the new staging system also had a good discriminatory ability to separate patients into different stages with 4 notably different curves and substages with 7 notably different curves. The new staging system had a better area under curve of time-dependent ROC than BCLC, TNM and CNLC staging in both SBRT and IMRT cohorts. Conclusions: The new modified (Su’s) staging system could provide a good discriminatory ability to separate patients into different stages and substages after radiotherapy treatment. It may be used to supplement the other HCC staging systems.

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