The eighth edition of the American Joint Committee on Cancer (AJCC) distant metastases (M) stage classification for metastatic pancreatic neuroendo...

A new interesting article has been published in Neuroendocrinology. 2019 Jul 30. doi: 10.1159/000502382. and titled:

The eighth edition of the American Joint Committee on Cancer (AJCC) distant metastases (M) stage classification for metastatic pancreatic neuroendo…

Authors of this article are:

Wen J, Chen J, Liu D, Xu X, Fan M, Zhang Z.

A summary of the article is shown below:

BACKGROUND: Significant modifications have been made in the eighth edition of the American Joint Committee on Cancer (AJCC) distant metastases (M) stage classification for metastatic pancreatic neuroendocrine tumors (Pan-NET). We aimed to validate this revised classification among metastatic Pan-NET patients using the Surveillance, Epidemiology, and End Results (SEER) database. We further sought to evaluate the feasibility of applying this classification to metastatic pancreatic neuroendocrine carcinoma (Pan-NEC) and pancreatic ductal adenocarcinoma (PDAC) patients.METHODS: Stage IV pancreatic neuroendocrine neoplasm (Pan-NEN, including G1/G2 Pan-NET, G3 Pan-NEC classified according to the WHO 2010 grading scheme) and PDAC patients with metastatic disease diagnosed between 2010 and 2015 were identified and restaged according to the revised M stage classification for Pan-NET. Overall survival (OS) was compared using the Kaplan-Meier analysis and log-rank test. Univariate and multivariate Cox regression models were utilized to identify prognostic factors.RESULTS: A total of 1371 stage IV Pan-NEN and 634 PDAC patients were included. Among Pan-NEN patients, liver (75.0%) was the most common metastatic site, followed by distant lymph node (8.5%), lung (8.4%), bone (7.3%) and brain (1.0%). The 5-year OS for Pan-NET patients with M1a, M1b and M1c stage were 44.15%, 53.32% and 19.70%, respectively. However, a survival comparison showed no significant difference between M1a and M1b stages among Pan-NET patients. Similar findings were noted after applying this classification to Pan-NEC patients. Multivariate analysis showed that the age at diagnosis and the number of distant metastatic sites were independent prognostic factors for metastatic Pan-NEN patients. Interestingly, excellent survival discrimination by M stage among stage IV PDAC patients was noted (M1a vs. M1b vs. M1c, 5-year OS: 5.42%, 2.46% and 0, respectively).CONCLUSION: Our study is the first large-sample size based validation of the AJCC 8th M stage classification for Pan-NET. The revised classification did not effectively stratify metastatic Pan-NEN patients. However, further study is warranted to validate this classification for Pan-NET patients according to the WHO 2017 classification. Interestingly, the revised M stage classification might be feasible for PDAC patients with metastatic disease.© 2019 S. Karger AG, Basel.

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[link-preview url=https://www.ncbi.nlm.nih.gov/pubmed/31357196 forceshot=true]

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