Validation of the 6 th edition AJCC pancreatic cancer staging system

Abstract

BACKGROUND. With the development of stage-specific treatments for pancreatic cancer, controversies exist concerning optimal clinical and pathologic staging. The most recent edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual 6th Edition included some notable modifications. In anticipation of the 7th edition's publication, the authors evaluated the predictive ability of the current pancreatic adenocarcinoma staging system. METHODS. By using the National Cancer Data Base (1992-1998), 121,713 patients were identified with pancreatic adenocarcinoma. All patients were restaged by AJCC 6th edition guidelines. Stage-specific overall survival was estimated by using the Kaplan-Meier method and compared with log-rank tests. Concordance indices were calculated to evaluate the discriminatory power of the staging system. Cox modeling was used to determine the relative impact of T, N, and M classification on survival. RESULTS. For all patients, there was 5-year survival discrimination by stage (P