Summary
Conclusion
A different stage grouping of TNM factors can improve the predictivity of the UICC TNM classification for pancreatic cancer. Nevertheless, the Japanese Pancreas Society (JPS) classification maintains a higher prognostic value.
Background
The use of a reliable staging classification facilitates the evaluation of anticancer treatments and the correct management of patients. The aim of the present study was to evaluate the prognostic value of three modified UICC TNM classifications, obtained by different stage grouping of the UICC TNM factors, comparing their predictivity to the standard UICC and the JPS classifications.
Methods
Clinical material consisted of 228 patients who underwent resection for pancreatic cancer. The reliability of the classifications was analyzed by the following methods: univariate analysis of stage survival curves; multivariate analysis of each classification after adjusting for grading and radicality; and correlation between the patients' distribution in the stages of each classification and in survival classes.
Results
The following modfiied UICC classification allowed a better differentiation of stage II and III survival (P=0.08) than standard UICC (p=0.74): stage I: T1N0M0; stage II: T1N1M0/T2N0M0: stage III: T2N1M0/T3 any NM0; stage IV: M1. The JPS classification better discriminated between the different stages (P<0.001). All classifications had an independent prognostic value by multivariate analysis. The correlation between stages and survival classes was higher for the JPS classification than either UICC TNM classification or the modified UICC classifications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hermanek P, Sobin LH, eds. UICC TNMClassification of Malignant Tumours, 4th ed., Springer-Verlag, Berlin, 1987.
Zerbi A, Balzano G, Bottura R, Di Carlo, V. Reliability of pancreatic cancer staging classifications.Int J Pancreatol 1994; 15: 13–18.
Tsunoda T, Ura K, Eto T, Matsumoto T, Tsuchiya R. UICC and Japanese stage classification for carcinoma of the pancreas.Int J Pancreatol 1991; 8: 205–214.
Bassi C, Butturini G, Falconi M, Iacono C, Serio G, Pederzoli P. Staging of pancreatic cancer: suggestions for a simplified, reliable modification of the TNM classification system.Int J Pancreatol 1995; 17: 213,214.
Klöppel G, Lingenthal G, von Bülow M, Kern HF. Histological and fine structural features of pancreatic ductal adenocarcinomas in relation to growth and prognosis: studies in xenografted tumours and clinicopathological correlation in a series of 75 casesHistopathology 1985; 9: 841–856.
Kaplan E, Meier P. Nonparametric estimation from incomplete observations.JR Stat Soc 1958; 8: 423–446.
Brookmeyer R, Crowley J. A confidence interval for the median survival time.Biometrics 1982; 38: 29–41.
Christensen E. Multivariate survival analysis using Cox's regression model.Hepatology 1987; 7: 1346–1358.
Hermreck AS, Thomas CY, Friesen SR. Importance of pathological staging in the surgical management of carcinoma of the exocrine pancreas.Am J Surg 1974; 127: 653–658.
Klöppel G, Sosnowski J, Eichfuss HP, Rückert K, Klapdor R. Aktuelle Aspekte des Pankreaskarzinoms.,Dtsch Med Wschr 1979; 104: 1801–1805.
Cancer of the Pancreas Task Force. Staging of cancer of the pancreas.Cancer 1981; 47: 1631–1637.
Hermanek P, Sobin LH, eds.UICC TNM Classification of Malignant Tumours, 4th ed., 2nd rev. Springer-Verlag, Berlin, 1992.
AJCC.Manual for Staging of Cancer, 4th ed., Lippincott, Philadelphia, 1992.
Japan Pancreas Society.General Rules for the Study of Pancreatic Cancer. 4th ed., Kanehara, Tokyo, 1993(in Japanese).
Japan Pancreas Society,Classification of Pancreatic Carcinoma, 1st English ed., Kanehara, Tokyo, 1996.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Balzano, G., Bassi, C., Zerbi, A. et al. Evaluation of UICC TNM classification for pancreatic cancer. International Journal of Pancreatology 21, 111–118 (1997). https://doi.org/10.1007/BF02822382
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02822382