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Validation of the 8th AJCC Cancer Staging System for Pancreas Neuroendocrine Tumors Using Korean Nationwide Surgery Database

Cancer Research and Treatment 2019년 51권 4호 p.1639 ~ 1652
 ( You Yung-Hun ) - Konkuk University School of Medicine Konkuk University Choongju Hospital Department of Surgery

 ( Jang Jin-Young ) - Seoul National University College of Medicine Department of Surgery
 ( Kim Song-Cheol ) - University of Ulsan College of Medicine Asan Medical Center Department of Surgery
 ( Yoon Yoo-Seok ) - Seoul National University Bundang Hospital Department of Surgery
 ( Park Joon-Seong ) - Yonsei University College of Medicine Gangnam Severance Hospital Department of Surgery
 ( Cho Chol-Kyoon ) - Chonnam National University Hwasun Hospital Department of Surgery
 ( Park Sang-Jae ) - National Cancer Center Center for Liver Cancer
 ( Yang Jae-Do ) - Chonbuk National University Medical School Department of Surgery
 ( Lee Woo-Jung ) - Yonsei University College of Medicine Severance Hospital Department of Surgery
 ( Hong Tae-Ho ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Hepatobiliary and Pancreas Surgery
 ( Ahn Keun-Soo ) - Keimyung University School of Medicine Dongsan Medical Center Department of Surgery
 ( Jeong Chi-Young ) - Gyeongsang National University School of Medicine Department of Surgery
 ( Lee Hyeon-Kook ) - Ewha Womans University School of Medicine Ewha Womans University Mokdong Hospital Department of Surgery
 ( Lee Seung-Eun ) - Chung-Ang University College of Medicine Department of Surgery
 ( Roh Young-Hoon ) - Dong-A University College of Medicine Department of Surgery
 ( Kim Hee-Joon ) - Chonnam National University Hospital Department of Surgery
 ( Kim Hong-Beom ) - Dongguk University College of Medicine Department of Surgery
 ( Han In-Woong ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Surgery


Purpose: The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic neuroendocrine tumor (PNET) included several significant changes. We aim to evaluate this staging system compared to the 7th edition AJCC staging system and European Neuroendocrine Tumors Society (ENETS) system.

Materials and Methods: We used Korean nationwide surgery database (2000-2014). Of 972 patients who had undergone surgery for PNET, excluding patients diagnosed with ENETS/World Health Organization 2010 grade 3 (G3), only 472 patients with accurate stage were included.

Results: Poor discrimination in overall survival rate (OSR) was noted between AJCC 8th stage III and IV (p=0.180). The disease-free survival (DFS) curves of 8th AJCC classification were well separated between all stages. Compared with stage I, the hazard ratio of II, III, and IV was 3.808, 13.928, and 30.618, respectively (p=0.007, p < 0.001, and p < 0.001). The curves of OSR and DFS of certain prognostic group in AJCC 7th and ENETS overlapped. In ENETS staging system, no significant difference in DFS between stage IIB versus IIIA (p=0.909) and IIIA versus IIIB (p=0.291). In multivariable analysis, lymphovascular invasion (p=0.002), perineural invasion (p=0.003), and grade (p < 0.001) were identified as independent prognostic factors for DFS.

Conclusion: This is the first large-scale validation of the AJCC 8th edition staging system for PNET. The revised 8th system provides better discrimination compared to that of the 7th edition and ENETS TNM system. This supports the clinical use of the system.


Validation; Neoplasm staging; Pancreatic neuroendocrine tumor
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