TY - JOUR
T1 - Multinational validation of the American Joint Committee on Cancer 8th edition pancreatic cancer staging system in a pancreas head cancer cohort
AU - Kwon, Wooil
AU - He, Jin
AU - Higuchi, Ryota
AU - Son, Donghee
AU - Lee, Seung Yeoun
AU - Kim, Jaeri
AU - Kim, Hongbeom
AU - Kim, Sun Whe
AU - Wolfgang, Christopher L.
AU - Cameron, John L.
AU - Yamamoto, Masakazu
AU - Jang, Jin Young
N1 - Funding Information:
Acknowledgments This study was funded by the National Research Foundation of Korea Grant (NRF-2016R1D1A1B03934908), and also by the Collaborative Genome Program for Fostering New Post-Genome Industry of the National Research Foundation funded by the Ministry of Science and ICT (NRF-2017M3C9A5031597).
Publisher Copyright:
© 2018 Japanese Society of Hepato-Biliary-Pancreatic Surgery
PY - 2018/9
Y1 - 2018/9
N2 - Background: The aim of the present study was to compare the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for pancreas head cancer and to validate the 8th edition using three multinational tertiary center data. Methods: Data of 2,864 patients with pancreas head cancer were collected from Korea (571), Japan (824), and the USA (1,469). Survival analysis was performed to compare the 7th and 8th editions. Validation was performed by log-rank tests and test for trend repeated 1,000 times with random sets. Results: In the 7th edition, 4.1%, 3.1%, 18.6%, 67.5%, 3.6%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV. In the 8th edition, 8.8%, 13.9%, 3.1%, 38.2%, 32.9%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV, respectively. The change in T category downstaged 459 patients from IIA to the new IA and IB. The new N2 category upstaged 856 patients from the former IIB to III. The 7th edition reversely stratified IA and IB. The 8th edition corrected this mis-stratification of the 7th edition, but lacked discriminatory power between IB and IIA (P = 0.271). Validation using the log-rank showed that the 8th edition provided better discrimination in 6.387 test sets among 10 tests. The test for trend validated the 8th edition to stratify stages in correct order more often (7.815/10). Conclusion: The 8th edition provides more even distribution with more powerful discrimination compared to the 7th edition.
AB - Background: The aim of the present study was to compare the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging system for pancreas head cancer and to validate the 8th edition using three multinational tertiary center data. Methods: Data of 2,864 patients with pancreas head cancer were collected from Korea (571), Japan (824), and the USA (1,469). Survival analysis was performed to compare the 7th and 8th editions. Validation was performed by log-rank tests and test for trend repeated 1,000 times with random sets. Results: In the 7th edition, 4.1%, 3.1%, 18.6%, 67.5%, 3.6%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV. In the 8th edition, 8.8%, 13.9%, 3.1%, 38.2%, 32.9%, and 3.1% were stage IA, IB, IIA, IIB, III, and IV, respectively. The change in T category downstaged 459 patients from IIA to the new IA and IB. The new N2 category upstaged 856 patients from the former IIB to III. The 7th edition reversely stratified IA and IB. The 8th edition corrected this mis-stratification of the 7th edition, but lacked discriminatory power between IB and IIA (P = 0.271). Validation using the log-rank showed that the 8th edition provided better discrimination in 6.387 test sets among 10 tests. The test for trend validated the 8th edition to stratify stages in correct order more often (7.815/10). Conclusion: The 8th edition provides more even distribution with more powerful discrimination compared to the 7th edition.
KW - American Joint Committee on Cancer
KW - Multinational
KW - Pancreas head cancer
KW - Stage
KW - Validation
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U2 - 10.1002/jhbp.577
DO - 10.1002/jhbp.577
M3 - Article
C2 - 30118171
AN - SCOPUS:85053842426
SN - 1868-6974
VL - 25
SP - 418
EP - 427
JO - Journal of Hepato-Biliary-Pancreatic Sciences
JF - Journal of Hepato-Biliary-Pancreatic Sciences
IS - 9
ER -