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Impact of Changes in the American Joint Committee on Cancer Staging Manual, Eighth Edition, for Pancreatic Ductal Adenocarcinoma

Kassardjian, Ari MD, PhD*; Stanzione, Nicholas MD*; Donahue, Timothy R. MD; Wainberg, Zev A. MD; Damato, Lauren MSN; Wang, Hanlin L. MD, PhD*

doi: 10.1097/MPA.0000000000001349
Original Articles

Objective Consistent and reliable tumor staging is a critical factor in determining treatment strategy, selection of patients for adjuvant therapy, and for therapeutic clinical trials. The aim of this study was to evaluate the number and extent of pancreatic ductal adenocarcinoma (PDAC) cases that would have a different pT, pN, and overall stages based on the new eighth edition American Joint Committee on Cancer staging system when compared with the seventh edition.

Methods Patients diagnosed with PDAC who underwent pancreaticoduodenectomy, total pancreatectomy, or distal pancreatectomy from 2007 to 2017 were retrospectively reviewed. A total of 340 cases were included.

Results According to the seventh edition, the vast majority of tumors in our cohort were staged as pT3 tumors (88.2%). Restaging these cases with the new size-based pT system resulted in a more equal distribution among the 3 pT categories, with higher percentage of pT2 cases (55%).

Conclusions The newly adopted pT stage protocol for PDAC is clinically relevant, ensures a more equal distribution among different stages, and allows for a significant prognostic stratification. In contrast, the new pN classification (pN1 and pN2) based on the number of positive lymph nodes failed to show survival differences and remains controversial.

From the Departments of *Pathology and Laboratory Medicine,

Surgery, and

Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Received for publication December 15, 2018; accepted May 16, 2019.

Address correspondence to: Hanlin L. Wang, MD, PhD, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA 90095 (e-mail:

Part of this study was presented in an abstract form at the United States and Canadian Academy of Pathology 107th Annual Meeting, Vancouver, British Columbia, Canada, March 17 to 23, 2018.

The authors declare no conflict of interest.

Online date: July 2, 2019

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