ArticleAnnals of surgical oncology2016
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.
Article in Annals of surgical oncology, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers.
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52 citing papers in PubMed, 124 citations in OpenAlex.
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- Extrapancreatic extension modifies chemotherapy benefit in resected pancreatic ductal adenocarcinoma: a population-based cohort study.Scientific reports · 2026Article
- Development and validation of a nomogram for predicting distant metastasis and prognosis in elderly T1-T2 pancreatic ductal adenocarcinoma patients.Discover oncology · 2026Article
- Small pancreatic ductal adenocarcinoma (≤ 2 cm): different imaging and clinicopathologic features according to extrapancreatic extension.Abdominal radiology (New York) · 2025Article
- Article
- ASO Author Reflections: Reshaping Tumor Size through Insights from Pancreatic Cancer Imaging and Pathology.Annals of surgical oncology · 2025Article
- Comparison of Ampullary and Pancreatic Adenocarcinomas: Smaller Invasion, Common Adenomatous Components, Resectability, and Histology are Factors for Improved Survival for Patients with Ampullary Adenocarcinoma.Annals of surgical oncology · 2025Article
- Distinct clinical outcomes and biological features of specific KRAS mutants in human pancreatic cancer.Cancer cell · 2024Article
- Enhancing Neoadjuvant Virotherapy's Effectiveness by Targeting Stroma to Improve Resectability in Pancreatic Cancer.Biomedicines · 2024Review
- Analysis of Recent Improvement of Survival Outcomes in Patients with Pancreatic Cancer Who Underwent Upfront Surgery.Gut and liver · 2024Article
- Imaging of pancreatic ductal adenocarcinoma - An update for all stages of patient management.European journal of radiology open · 2024Article
- Reconsidering the absence of extrapancreatic extension in T staging for pancreatic adenocarcinoma in the AJCC (8Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2023Article
- Utility of intraoperative pathology consultations of whipple resection specimens and their impact on final margin status.Heliyon · 2023Article
- Accuracy of models to prognosticate survival after surgery for pancreatic cancer in the era of neoadjuvant therapy.Journal of surgical oncology · 2023Article
- The prognostic significance of duodenal wall invasion in pancreatic adenocarcinoma.World journal of surgical oncology · 2023Review
- Presence of tumor deposits is an indicator of poor prognosis in patients with pancreatic ductal adenocarcinoma.American journal of cancer research · 2023Article
- Evaluation of the 8th Edition AJCC Staging System for the Clinical Staging of Pancreatic Cancer.Cancers · 2022Article
- Nationwide Validation of the 8th American Joint Committee on Cancer TNM Staging System and Five Proposed Modifications for Resected Pancreatic Cancer.Annals of surgical oncology · 2022Article
- Tumour Size and T-Stage in Pancreatic Cancer Resection Specimens Depend on the Pathology Examination Approach.Cancers · 2022Article
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Authors and funding
19 authors at 5 institutions in 2 countries.
Funding
Abstract
backgroundMost 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.
methodsTo document the parameters included in this T-stage protocol, 223 consecutive pancreatoduodenectomy specimens with PDAC were processed by a uniform grossing protocol.
resultsPeripancreatic 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 %, 20 %, respectively (p < 0.0001). The association between higher T-stage and shorter survival persisted in N0 cases and in multivariate modeling. Analysis of the Surveillance, Epidemiology, and End Results database also confirmed the survival differences (p < 0.0001).
conclusionsThis study showed that resected PDACs are already spread to various surfaces of the pancreas, leaving only about 4 % of PDACs to truly qualify as pT1/T2, and that the current T-stage protocol does not have any prognostic correlation. In contrast, as shown previously in many studies, size is an important prognosticator, and a size-based T-stage protocol is more applicable and has prognostic value in PDAC.
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