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Prognostic Validity of the American Joint Committee on Cancer Eighth Edition TNM Staging System for Surgically Treated and Well-Differentiated Pancreatic Neuroendocrine Tumors

A Comprehensive Analysis of 254 Consecutive Patients From a Large Chinese Institution

Yang, Min, MD*; Zhang, Yi, MD; Zeng, Lin, MD; Ke, Neng-wen, MD; Tan, Chun-lu, MD; Tian, Bo-le, PhD; Xiang, Bo, PhD*; Liu, Xu-bao, PhD

doi: 10.1097/MPA.0000000000001305
Original Articles

Objectives We aimed to validate the novel American Joint Committee on Cancer (AJCC) eighth edition staging manual for well-differentiated (G1/G2) pancreatic neuroendocrine tumors (pNETs).

Methods Data of eligible patients were retrospectively collected, grouped, and analyzed by applying the new AJCC system.

Results According to the AJCC eighth staging manual for pNETs, 93, 66, 53, and 42 patients had stage I, II, III, and IV disease, respectively, with estimated 5-year overall survival (OS) rates of 96.9%, 92.8%, 48.4%, and 16.8% (P < 0.005), respectively. A total of 57, 28, 20, and 17 patients with G1 pNETs and 36, 38, 33, and 25 ones with G2 tumors were defined by the new AJCC system as having stage I, II, III, and IV disease, respectively. The estimated 5-year OS for stage I, II, III and IV disease was 100.0%, 97.1%, 52.5%, and 18.2%, respectively, for G1 pNETs (P < 0.005) and 94.2%, 90.3%, 38.7%, and 12.7%, respectively, for G2 tumors (P < 0.005). The novel AJCC classification, tumor grading, and radical resection were all prognostic predictors for OS in patients with pNETs.

Conclusions The new AJCC eighth staging system for well-differentiated pNETs was prognostic and might be adopted in clinical practice.

From the Departments of *Pediatric Surgery and

Pancreatic Surgery, and

President & Dean's Office, West China Hospital of Sichuan University, Chengdu, China.

Received for publication October 2, 2018; accepted March 18, 2019.

Address correspondence to: Xu-bao Liu, PhD, Department of Pancreatic Surgery, West China Hospital of Sichuan University, Guoxue Road No. 37, Wuhou District, Chengdu, Sichuan Province 610041, China (e-mail:

M.Y. and Y.Z. contributed equally to this work as first authors.

B.X. and X.L. contributed equally as senior authors.

This research was sponsored by the 1.3.5. Project Disciplines of Excellence, West China Hospital, Sichuan University.

The authors declare no conflict of interest.

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