Understaging of clinical stage I pancreatic cancer and the impact of multimodality therapy

Baugh, Katherine A.; Cao, Hop S. Tran; Buren, George Van; Silberfein, Eric J.; Hsu, Cary; Chai, Christy; Barakat, Omar; Fisher, William E.; Massarweh, Nader N.

doi:10.1016/j.surg.2018.08.003

Cited by 19 publications

(25 citation statements)

References 17 publications

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“…11,19 For pancreatic cancer, nearly 75% of patients believed to have stage I disease have higher stage disease on final pathology, and half of the patients believed to be node-negative actually have lymph node metastases. 9,20 Although prior studies have characterized the accuracy of clinical staging information, the majority of available data is derived from either tertiary referral centers in the US or from large European multi-center cohorts. 18,[21][22][23] Because more than 80% of patients with cancer in the US receive their care outside of specialized centers, information regarding hospital-level clinical staging performance in the general community represents an important knowledge gap.…”

Section: Discussionmentioning

confidence: 99%

Hospital clinical staging accuracy for upper gastrointestinal malignancy

Costa

Cao

Portuondo

et al. 2020

Journal of Surgical Oncology

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Background: Decisions about multimodality treatment for upper gastrointestinal malignancies are largely predicted on clinical staging information. However, hospital-level accuracy of clinical staging is currently unknown. Methods: A national cohort study of patients with adenocarcinoma of the esophagus, stomach, or pancreas in the NCDB (2006-2015) who were treated with upfront resection. Hospital-level staging accuracy (ascertained by comparing clinical stage to pathologic stage) was calculated. Within hospital correlation of staging accuracy across disease sites was evaluated using risk and reliability adjustment. Results: Overall, 1246 hospitals were evaluated. Median hospital T-staging accuracy was 77.5%, 73.7%, and 60.8% for esophageal, gastric, and pancreatic cancer, respectively. Median hospital N-staging accuracy was 80.2%, 72.9%, and 61.8%, respectively. For T-stage, over-staging was most frequently observed in esophageal patients (11.2%) while under-staging was most frequent in pancreatic patients (36.1%). For N-stage, over-staging was infrequent for all three, while under-staging was most common in pancreatic patients (37.4%). Correlation across disease sites was weak for both T-(best observed, r = .34) and N-stages (r = .30). When high volume hospitals were evaluated, correlation improved but accuracy rates were similar. Conclusions: Despite the importance of clinical staging in multimodality treatment planning, hospitals inaccurately stage 20-40% of patients, with low correlation across disease sites.

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Section: Discussionmentioning

confidence: 99%

Hospital clinical staging accuracy for upper gastrointestinal malignancy

Costa

Cao

Portuondo

et al. 2020

Journal of Surgical Oncology

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“…that lymph node status in the TNM 8 has more prognostic significance. Unfortunately, preoperative lymph node status in pancreatic cancer is difficult to assess and up to 75 per cent of clinically staged N0 disease is upstaged to N1 disease at pathological assessment. Improved imaging strategies are needed to enable selection of patients for neoadjuvant therapy based on preoperative lymph node status.…”

Section: Overall Survival By Lymph Node Status and Radicalitymentioning

confidence: 99%

Author response to: Resection margin status in pancreatic cancer surgery: is it really less important than the N status?

Groen

Tummers

Mieog

et al. 2019

British Journal of Surgery

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“…[7][8][9][10] Moreover, surgical resection is enough for some patients with stage I disease on final pathology and they might be overtreated by adjuvant therapy. 11 Therefore, predicting the prognosis of stage I and II PDAC patients after surgery is of significant importance to treatment decision and patient management.…”

Section: Introductionmentioning

confidence: 99%

“…About three quarters of clinical stage I patients actually have higher stage on final pathology, of which nearly a half lymph node is positive. 11 About 10% of patients with Lewis antigen negative are unable to express CA 19-9, 12 and some locally advanced or metastatic pancreatic carcinoma show a low CA 19-9 concentration, 13 which limit the prognostic ability of High-throughput molecular analysis has emerged as a powerful tool to look for the prognostic signatures of tumor patients. For PDAC patients after surgery, many prognostic signatures have been developed for predicting the prognosis.…”

Section: Introductionmentioning

confidence: 99%

A qualitative transcriptional prognostic signature for patients with stage I-II pancreatic ductal adenocarcinoma

Huang

Zou

Zhang

et al. 2020

Translational Research

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Accurately prognostic evaluation of patients with stage I-II pancreatic ductal adenocarcinoma (PDAC) is of importance to treatment decision and patient management. Most previously reported prognostic signatures were based on risk scores summarized from quantitative expression measurements of signature genes, which are susceptible to experimental batch effects and impractical for clinical applications. Based on the within-sample relative expression orderings of genes, we developed a robust qualitative transcriptional prognostic signature, consisting of 64 gene pairs (64-GPS), to predict the overall survival (OS) of 161 stage I-II PDAC patients in the training dataset who were treated with surgery only. Samples were classified into the high-risk group when at least 25 of 64 gene pairs suggested it was at high risk. The signature was successfully validated in 324 samples from 6 independent datasets produced by different laboratories. All samples in the low-risk group had significantly better OS than samples in the high-risk group. Multivariate Cox regression analyses showed that the 64-GPS remained significantly associated with the OS of patients after adjusting available clinical factors. Transcriptomic analysis of the 2 prognostic subgroups showed that the differential expression signals were highly reproducible in all datasets, whereas the differences between samples grouped by the TNM staging system were weak and irreproducible. The epigenomic analysis showed that the epigenetic alternations may cause consistently transcriptional changes between the 2 different prognostic groups. The genomic analysis revealed that mutation-induced disturbances in several key genes, such as LRMDA, MAPK10, and CREBBP, might lead to poor prognosis for PDAC patients. Conclusively, the 64-GPS can robustly predict the prognosis of patients with stage I-II PDAC, which provides theoretical basis for clinical individualized treatment.

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Understaging of clinical stage I pancreatic cancer and the impact of multimodality therapy

Cited by 19 publications

References 17 publications

Hospital clinical staging accuracy for upper gastrointestinal malignancy

Hospital clinical staging accuracy for upper gastrointestinal malignancy

Author response to: Resection margin status in pancreatic cancer surgery: is it really less important than the N status?

A qualitative transcriptional prognostic signature for patients with stage I-II pancreatic ductal adenocarcinoma

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