Consideration of Age Is Necessary for Increasing the Accuracy of the AJCC TNM Staging System of Pancreatic Neuroendocrine Tumors

Zhengshi Wang; Wenli Jiang; Lijuan Zheng; Jie Yan; Jiaqi Dai; Caiguo Huang; Qian Zhang; Zhiqiang Yin; Xiangnan Gong; Yun Zhang

doi:10.3389/fonc.2019.00906

Consideration of Age Is Necessary for Increasing the Accuracy of the AJCC TNM Staging System of Pancreatic Neuroendocrine Tumors

Front Oncol. 2019 Sep 19:9:906. doi: 10.3389/fonc.2019.00906. eCollection 2019.

Authors

Zhengshi Wang^{1

2}, Wenli Jiang³, Lijuan Zheng⁴, Jie Yan^{1

2}, Jiaqi Dai^{1

2}, Caiguo Huang³, Qian Zhang⁵, Zhiqiang Yin^{1

2}, Xiangnan Gong⁶, Yun Zhang^{1

2}

Affiliations

¹ Thyroid Center, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
² Shanghai Center for Thyroid Diseases, Shanghai, China.
³ Department of Biochemistry and Molecular Biology, The Faculty of Basic Medical Science, Second Military Medical University, Shanghai, China.
⁴ Department of Gastroenterology, Gansu Provincial Hospital, Lanzhou, China.
⁵ Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
⁶ Department of Thoracic Surgery, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou, China.

Abstract

Purpose: Currently, of the two most common staging systems of pancreatic neuroendocrine tumors (pNETs) one is from the European Neuroendocrine Tumor Society (ENETS) and the other is from the American Joint Committee on Cancer (AJCC). However, there are imperfections in both these staging systems. Patients and methods: Patients were selected retrospectively from the Surveillance Epidemiology and End Results (SEER) database (2004 to 2013). The effect of age on the hazard ratio (HR) was evaluated using restricted cubic splines. The discriminatory power of the staging systems was determined using the concordance index (C-index). Results: A total of 3,034 patients with pNETs were included in the final analyses. The risk of death increased slowly along with age for patients under 60 years of age, but the risk of death rose sharply for those over 60 years of age, forming a mirrored L-shaped survival curve. In the current AJCC tumor-node-metastasis (TNM) staging system, no statistical significance was observed between stages IA and IB (p = 0.105). Patients with stage IIB even had longer OS than patients with IIA, although there was no statistical significance (p = 0.574). The proportion of stage III patients was small (2.7%). In the proposed aTNM staging system, significant survival differences could be observed among stage I, IIA, and IIB (p < 0.001) and the proportion of stage III rose from 2.7 to 25.7%. Conclusion: Our findings suggest that age has a critical influence on the survival of patients with pNETs. Age should be considered as a factor in future staging systems of pNETs.

Keywords: AJCC; SEER; age; overall survival; pancreatic neuroendocrine tumor.