Modified TNM staging system for well-differentiated pancreatic neuroendocrine tumors: A comparative study with the AJCC 9th edition.

IF 2.7 2区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Pancreatology Pub Date : 2025-09-30 DOI:10.1016/j.pan.2025.09.034

Min Yang, Jie-Yu Wen, Gui-Zhen Qian, Ting Yang, Xu-Bao Liu, Bo-le Tian, Yi Zhang, Yi Ji

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引用次数: 0

Abstract

Background: Continuing to use the 8th edition criteria, the current American Joint Committee on Cancer (AJCC) 9th staging system has been demonstrated to fail to distinguish prognosis in Stage I between Stage II for patients with G1/G2 pancreatic neuroendocrine tumors (p-NETs). A modified tumor-node-metastasis (mTNM) system with revised nodal classification was previously proposed, but hasn't been comprehensively validated by large-scale institutional studies.

Methods: Data of eligible patients was retrospectively collected and distributed by the proposed mTNM staging system and the current AJCC 9th staging system. The staging characteristics for G1/G2/G3 p-NETs were respectively performed and compared by two systems.

Results: Our study enrolled 310 patients with well-differentiated p-NETs, including 122 ones with G1, 132 with G2 and 56 with G3. The 5-year overall survival (OS) from AJCC Stage I to Stage IV was respectively 79.0 %, 88.8 %, 39.5 % and 15.8 %, in which survival comparison between Stage I and Stage II wasn't significant (P = 0.114). The OS at 5 years from mTNM Stage I to Stage IV was respectively 93.4 %, 75.5 %, 34.1 % and 15.8 %, in which notable survival differences were offered among each stage (P < 0.05). Moreover, consistent with the results of Akaike information criteria and Harrell's concordance index, the 95 % confidence intervals in multivariate analysis for proposed mTNM staging system were smaller than that of AJCC 9th staging system, indicating a more accurate predictive ability for the OS of G1/G2/G3 p-NETs.

Conclusion: The proposed mTNM staging system was superior to the current AJCC 9th system for well-differentiated p-NETs.

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改良的TNM分期系统用于分化良好的胰腺神经内分泌肿瘤：与AJCC第9版的比较研究。

背景：继续使用第8版标准，目前的美国癌症联合委员会（AJCC）第9分期系统已被证明无法区分G1/G2胰腺神经内分泌肿瘤（p-NETs）患者的I期和II期预后。先前提出了一种改进的肿瘤-淋巴结-转移（mTNM）系统，该系统修改了淋巴结分类，但尚未得到大规模机构研究的全面验证。方法：回顾性收集符合条件的患者的资料，并按照拟议的mTNM分期系统和现行的AJCC第9分期系统进行分配。G1/G2/G3 p-NETs的分期特征分别采用两种系统进行比较。结果：我们的研究纳入了310例高分化p-NETs患者，其中G1 122例，G2 132例，G3 56例。AJCC I期至IV期的5年总生存率（OS）分别为79.0%、88.8%、39.5%和15.8%，其中I期与II期生存率比较无统计学意义（P = 0.114）。mTNM I期至IV期5年生存率分别为93.4%、75.5%、34.1%、15.8%，各期生存率差异有统计学意义（P < 0.05）。此外，与Akaike信息标准和Harrell的一致性指数结果一致，mTNM分期系统的多变量分析95%置信区间小于AJCC第9期分期系统，表明对G1/G2/G3 p-NETs的OS有更准确的预测能力。结论：对于分化良好的p-NETs， mTNM分期系统优于AJCC第九期分期系统。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pancreatology 医学-胃肠肝病学

CiteScore

7.20

自引率

5.60%

发文量

194

审稿时长

44 days

期刊介绍： Pancreatology is the official journal of the International Association of Pancreatology (IAP), the European Pancreatic Club (EPC) and several national societies and study groups around the world. Dedicated to the understanding and treatment of exocrine as well as endocrine pancreatic disease, this multidisciplinary periodical publishes original basic, translational and clinical pancreatic research from a range of fields including gastroenterology, oncology, surgery, pharmacology, cellular and molecular biology as well as endocrinology, immunology and epidemiology. Readers can expect to gain new insights into pancreatic physiology and into the pathogenesis, diagnosis, therapeutic approaches and prognosis of pancreatic diseases. The journal features original articles, case reports, consensus guidelines and topical, cutting edge reviews, thus representing a source of valuable, novel information for clinical and basic researchers alike.