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

Annals of Surgical Oncology
Burcu SakaVolkan Adsay

Abstract

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. 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 %...Continue Reading

References

Jan 1, 1993·American Journal of Surgery·R J Geer, M F Brennan
Jun 22, 2000·Journal of Surgical Oncology·P MagistrelliA Picciocchi
Apr 18, 2001·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·T A SohnK D Lillemoe
Nov 22, 2001·Lancet·J P NeoptolemosUNKNOWN European Study Group for Pancreatic Cancer
Mar 19, 2004·The New England Journal of Medicine·John P NeoptolemosUNKNOWN European Study Group for Pancreatic Cancer
Jul 27, 2004·Annals of Surgery·Murray F BrennanKevin Conlon
Jun 29, 2006·The British Journal of Surgery·C S VerbekeA Anthoney
Sep 7, 2006·Annals of Surgical Oncology·Roderich E Schwarz, David D Smith
Nov 23, 2006·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Jordan M WinterCharles J Yeo
May 9, 2007·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·David S Klimstra
Jun 27, 2007·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Gaku MatsumotoAtsutake Okamoto
Aug 22, 2007·Archives of Surgery·James S TomlinsonClifford Y Ko
Sep 6, 2007·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Michael G HousePeter J Allen
Mar 21, 2008·Annals of Surgical Oncology·Irene EspositoMarkus W Büchler
Sep 30, 2008·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·N Volkan AdsayCharles Staley
Nov 18, 2008·World Journal of Surgery·Michio UedaHiroshi Shimada
Apr 24, 2009·Annals of Surgical Oncology·Douglas B EvansRichard D Schulick
Jul 8, 2009·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Dong Do YouDong Wook Choi
Sep 1, 2009·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Caroline S Verbeke, Krishna V Menon
Feb 25, 2010·Annals of Surgical Oncology·Stephen B Edge, Carolyn C Compton
Apr 28, 2010·Virchows Archiv : an International Journal of Pathology·Günter KlöppelDavid S Klimstra
Feb 2, 2011·Journal of Surgical Oncology·Mechteld C de JongTimothy M Pawlik
May 25, 2011·Annals of Surgery·Werner HartwigJens Werner
Nov 16, 2011·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Tara S KentMark P Callery
Apr 21, 2012·The British Journal of Surgery·C S Verbeke, I P Gladhaug
Jul 6, 2012·Surgery·Cristina R FerroneAndrew L Warshaw
Oct 19, 2012·Journal of Gastrointestinal Cancer·Vinayak S RohanTsann-Long Hwang
Feb 5, 2013·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Vlad MaksymovMahmoud A Khalifa
Sep 17, 2013·Journal of Surgical Oncology·Marianne SinnHelmut Oettle
Oct 10, 2013·JAMA : the Journal of the American Medical Association·Helmut OettleHanno Riess
Jan 1, 2010·Cancers·Anna Melissa Schlitter, Irene Esposito
Jan 22, 2014·International Surgery·Alireza Hamidian JahromiHosein Shokouh-Amiri
Mar 19, 2014·Seminars in Radiation Oncology·Matthew H G KatzGauri Varadhachary

❮ Previous
Next ❯

Citations

Oct 28, 2016·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Raul S GonzalezN Volkan Adsay
Mar 6, 2017·Critical Reviews in Oncology/hematology·Nicola SilvestrisStefano Cascinu
May 31, 2017·APMIS : Acta Pathologica, Microbiologica, Et Immunologica Scandinavica·Sehhoon ParkHo-Seong Han
Jul 28, 2016·Annals of Surgery·Oliver Strobel, Markus W Büchler
Oct 2, 2019·Diagnostics·Jiaqi Shi, Olca Basturk
Jul 28, 2016·Annals of Surgery·Stefano CrippaMassimo Falconi
Dec 12, 2019·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Wooil KwonJin-Young Jang
Jun 19, 2020·World Journal of Gastrointestinal Pharmacology and Therapeutics·Feng YinXiuli Liu
Jul 29, 2017·Annals of Surgical Oncology·Yun Shin ChunJean-Nicolas Vauthey
Nov 24, 2018·Modern Pathology : an Official Journal of the United States and Canadian Academy of Pathology, Inc·Claudio LuchiniRita T Lawlor
Apr 16, 2021·Langenbeck's Archives of Surgery·Takatsugu MatsumotoYasuhiro Shimada
Aug 5, 2021·European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology·Anna-Katharina KönigOliver Strobel

❮ Previous
Next ❯

Related Concepts

Related Feeds

Carcinoma, Ductal

Ductal carcinoma is a malignant neoplasm involving the ductal systems of any of a number of organs, such as the mammary glands, pancreas, prostate or lacrimal gland. Discover the latest research on ductal carcinoma here.