A new staging system for postoperative prognostication in pancreatic ductal adenocarcinoma

Yuexiang Liang; Jingli Cui; Fanghui Ding; Yiping Zou; Hanhan Guo; Quan Man; Shaofei Chang; Song Gao; Jihui Hao

doi:10.1016/j.isci.2023.107589

A new staging system for postoperative prognostication in pancreatic ductal adenocarcinoma

iScience. 2023 Aug 9;26(9):107589. doi: 10.1016/j.isci.2023.107589. eCollection 2023 Sep 15.

Authors

Yuexiang Liang^{1

2}, Jingli Cui^{1

3}, Fanghui Ding⁴, Yiping Zou¹, Hanhan Guo², Quan Man¹, Shaofei Chang^{1

5}, Song Gao¹, Jihui Hao¹

Affiliations

¹ Department of Pancreatic Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center For Cancer, Tianjin 30060, China.
² Department of Gastrointestinal Oncology Surgery, Center of Cancer Prevention and Therapy, the First Affiliated Hospital of Hainan Medical University, Haikou 570102, China.
³ Department of General Surgery, Weifang People's Hospital, Weifang 261044, China.
⁴ Department of General Surgery, the First Hospital of Lanzhou University, Lanzhou 730013, China.
⁵ Department of Gastrointestinal Pancreatic Surgery, Shanxi Provincial People's Hospital, Taiyuan 030012, China.

Abstract

The current TNM staging system for pancreatic ductal adenocarcinoma (PDAC) has revised the definitions of T and N categories as well as stage groups. However, studies validating these modifications have yielded inconsistent results. The existing TNM staging system in prognostic prediction remains unsatisfactory. The prognosis of PDAC is closely associated with pathological and biological factors. Herein, we propose a new staging system incorporating distant metastasis, postoperative serum levels of CA19-9 and CEA, tumor size, lymph node metastasis, lymphovascular involvement, and perineural invasion to enhance the accuracy of prognosis assessment. The proposed staging system exhibited a strong correlation with both overall survival and recurrence-free survival, effectively stratifying survival into five distinct tiers. Additionally, it had favorable discrimination and calibration. Thus, the proposed staging system demonstrates superior prognostic performance compared to the TNM staging system, and can serve as a valuable complementary tool to address the limitations of TNM staging in prognostication.

Keywords: Biological process; Cancer; Cancer systems biology; Data processing in systems biology.