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©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Stage III should be subclassified into Stage IIIA and IIIB in the American Joint Committee on Cancer (8th Edition) staging system for pancreatic cancer
Hai-Feng Yu, Bing-Qing Zhao, Yong-Cheng Li, Jun Fu, Wei Jiang, Rong-Wei Xu, Hao-Chang Yang, Xiao-Jun Zhang
Hai-Feng Yu, Wei Jiang, Department of General Surgery, Tianjin First Central Hospital, Tianjin 300192, China
Bing-Qing Zhao, Department of Surgery, Tianjin Second People’s Hospital, Tianjin 300192, China
Yong-Cheng Li, Department of Medical Oncology, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou 221009, Jiangsu Province, China
Jun Fu, Xiao-Jun Zhang, Department of Hepatic-Biliary-Pancreatic-Splenic Surgery, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, Xuzhou 221009, China
Rong-Wei Xu, Department of Vascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan 250014, China
Hao-Chang Yang, College of Clinical Medicine, Binzhou Medical University, Yantai 264003, China
Author contributions: Yu HF and Zhang XJ designed the research and critically revised the manuscript for important intellectual content; all authors performed the research, analyzed the data, and wrote the paper.
Conflict-of-interest statement: All authors declare no competing financial interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Jun Zhang, MD, Doctor, Department of Hepatic Biliary Pancreatic Splenic Surgery, XuZhou Central Hospital, The Affiliated XuZhou Hospital of Medical College of Southeast University, No.199 South Jiefang Road, Xuzhou 221009, Jiangsu Province, China.
exiaojun@163.com.
Telephone: +86-18012018746
Received: March 19, 2018
Peer-review started: March 20, 2018
First decision: March 30, 2018
Revised: April 5, 2018
Accepted: May 5, 2018
Article in press: May 5, 2018
Published online: June 14, 2018
Processing time: 83 Days and 11.6 Hours
AIM
To ascertain the prognostic role of the T4 and N2 category in stage III pancreatic cancer according to the 8th edition of the American Joint Committee on Cancer (AJCC) classification.
METHODS
Patients were collected from the Surveillance Epidemiology and End Results (SEER) database (2004-2013) and were divided into three groups: T(1-3)N2, T4N(0-1), and T4N2. Overall survival (OS) and disease-specific survival (DSS) of patients were evaluated by the Kaplan-Meier method.
RESULTS
For the first time, we found a significant difference in OS and DSS between T(1-3)N2/T4N(0-1) and T4N2 but not between T(1-3)N2 and T4N(0-1). A higher grading correlated with a worse prognosis in the T(1-3)N2 and T4N2 groups.
CONCLUSION
Patients with stage T4N2 had a worse prognosis than those with stage T(1-3)N2/T4N(0-1) in the 8th edition AJCC staging system for pancreatic cancer. We recommend that stage III should be subclassified into stage IIIA [T(1-3)N2/T4N(0-1)] and stage IIIB (T4N2).
Core tip: The 8th edition American Joint Committee on Cancer TNM criteria for pancreatic cancer incorporated several significant changes of Stage III. T4 and N2 categories were defined as two key parameters of Stage III. Thus, we used the Surveillance Epidemiology and End Results database, a population-based database, to evaluate the new changes in pancreatic cancer staging and the prognostic factors.
