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Invited Commentary
December 19, 2018

The New American Joint Committee on Cancer TNM Staging System for Pancreatic Cancer—Balancing Usefulness With Prognostication

Author Affiliations
  • 1Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles
JAMA Surg. 2018;153(12):e183629. doi:10.1001/jamasurg.2018.3629

In the current issue of JAMA Surgery, van Roessel et al1 used data from 1525 patients with resected pancreatic cancer treated in 5 medical centers in the United States and Europe to compare the performance of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging system with the seventh edition. The authors found that 774 patients (50.8%) migrated to a different stage, with most of these (591 patients [38.8% of the total]) moving to a higher stage. The predictive ability of the 2 editions was comparable, with a concordance statistic of close to 0.60 for both. When evaluating the T stage alone, neither the seventh edition nor the eighth edition proved useful for distinguishing a patient’s overall survival (log-rank P values for both editions were not statistically significant). In contrast, the new N-staging in the eighth edition proved highly discriminative for overall survival. In addition, the authors assessed 2 proposed modifications to the eighth edition staging system, neither of which demonstrated additional discriminatory ability.

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