Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database
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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.
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.
참고문헌 (29)
- Amin MB, "AJCC cancer staging manual" (2017), Springer
- Yao JC, "Population-based study of islet cell carcinoma", Ann Surg Oncol, 14, pp.3492~3500 (2007)
- Panzuto F, "Metastatic and locally advanced pancreatic endocrine carcinomas : analysis of factors associated with disease progression", J Clin Oncol, 29, pp.2372~2377 (2011)
- Modlin IM, "Priorities for improving the management of gastroenteropancreatic neuroendocrine tumors", J Natl Cancer Inst, 100, pp.1282~1289 (2008)
- Yao JC, "One hundred years after"carcinoid" : epidemiology of and prognostic factors for neuroendocrine tumors in 35, 825 cases in the United States", J Clin Oncol, 26, pp.3063~3072 (2008)
- Rindi G, "TNM staging of foregut(neuro)endocrine tumors : a consensus proposal including a grading system", Virchows Arch, 449, pp.395~401 (2006)
- Rindi G, "TNM staging of neoplasms of the endocrine pancreas : results from a large international cohort study", J Natl Cancer Inst, 104, pp.764~777 (2012)
- Fischer L, "Clinical outcome and long-term survival in 118 consecutive patients with neuroendocrine tumours of the pancreas", Br J Surg, 95, pp.627~635 (2008)
- La Rosa S, "Improved histologic and clinicopathologic criteria for prognostic evaluation of pancreatic endocrine tumors", Hum Pathol, 40, pp.30~40 (2009)
- Ekeblad S, "Prognostic factors and survival in 324 patients with pancreatic endocrine tumor treated at a single institution", Clin Cancer Res, 14, pp.7798~7803 (2008)
- Scarpa A, "Pancreatic endocrine tumors : improved TNM staging and histopathological grading permit a clinically efficient prognostic stratification of patients", Mod Pathol, 23, pp.824~833 (2010)
- Yang M, "TNM staging of pancreatic neuroendocrine tumors: an observational analysis and comparison by both AJCC and ENETS systems from 1 single institution", Medicine (Baltimore), 94, pp.e660~ (2015)
- Bilimoria KY, "Application of the pancreatic adenocarcinoma staging system to pancreatic neuroendocrine tumors", J Am Coll Surg, 205, pp.558~563 (2007)
- Strosberg JR, "Prognostic validity of a novel American Joint Committee on Cancer Staging Classification for pancreatic neuroendocrine tumors", J Clin Oncol, 29, pp.3044~3049 (2011)
- Strosberg JR, "Relapse-free survival in patients with nonmetastatic, surgically resected pancreatic neuroendocrine tumors : an analysis of the AJCC and ENETS staging classifications", Ann Surg, 256, pp.321~325 (2012)
- Ellison TA, "A single institution's 26-year experience with nonfunctional pancreatic neuroendocrine tumors : a validation of current staging systems and a new prognostic nomogram", Ann Surg, 259, pp.204~212 (2014)
- Rindi G, "The ENETS guidelines : the new TNM classification system", Tumori, 96, pp.806~809 (2010)
- Martin RC, "Analysis of 6, 747 pancreatic neuroendocrine tumors for a proposed staging system", J Gastrointest Surg, 15, pp.175~183 (2011)
- Rindi G, "WHO classification of tumours of the digestive system", pp.13~14 (2010), IARC
- Edge SB, "AJCC cancer staging manual" (2010), Springer
- Luo G, "Modified staging classification for pancreatic neuroendocrine tumors on the basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society systems", J Clin Oncol, 35, pp.274~280 (2017)
- Hashim YM, "Regional lymphadenectomy is indicated in the surgical treatment of pancreatic neuroendocrine tumors (PNETs)", Ann Surg, 259, pp.197~203 (2014)
- Krampitz GW, "Lymph nodes and survival in pancreatic neuroendocrine tumors", Arch Surg, 147, pp.820~827 (2012)
- Parekh JR, "Lymph node sampling rates and predictors of nodal metastasis in pancreatic neuroendocrine tumor resections : the UCSF experience with 149 patients", Pancreas, 41, pp.840~844 (2012)
- Nakakura EK, "Challenges staging neuroendocrine tumors of the pancreas, jejunum and ileum, and appendix", Ann Surg Oncol, 25, pp.591~593 (2018)
- Shiba S, "Pancreatic neuroendocrine tumors : a single-center 20-year experience with 100 patients", Pancreatology, 16, pp.99~105 (2016)
- Castellano D, "Expert consensus for the management of advanced or metastatic pancreatic neuroendocrine and carcinoid tumors", Cancer Chemother Pharmacol, 75, pp.1099~1114 (2015)
- Ramirez RA, "The role of capecitabine", temozolomide in metastatic neuroendocrine tumors, 2016, pp.21, 671~675
- Rinke A, "Placebo-controlled, double-blind, prospective, randomized study on the effect of octreotide LAR in the control of tumor growth in patients with metastatic neuroendocrine midgut tumors : a report from the PROMID Study Group", J Clin Oncol, 27, pp.4656~4663 (2009)