[Pancreas] 췌장암, TNM staging AJCC UICC 8th edition

췌장암 (exocrine, neuroendocrine)의 선호되는 staging system은 the combined American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC)의 tumor, node, metastasis (TNM) system입니다.

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Exocrine pancreatic cancer TNM staging AJCC UICC 8th edition

Primary tumor (T)
T category	T criteria
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
Tis	Carcinoma in situ. This includes high-grade pancreatic intraepithelial neoplasia (PanIn-3), intraductal papillary mucinous neoplasm with high-grade dysplasia, intraductal tubulopapillary neoplasm with high-grade dysplasia, and mucinous cystic neoplasm with high-grade dysplasia.
T1	Tumor ≤2 cm in greatest dimension
T1a	Tumor ≤0.5 cm in greatest dimension
T1b	Tumor >0.5 and <1 cm in greatest dimension
T1c	Tumor 1 to 2 cm in greatest dimension
T2	Tumor >2 and ≤4 cm in greatest dimension
T3	Tumor >4 cm in greatest dimension
T4	Tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic artery, regardless of size
Regional lymph nodes (N)
N category	N criteria
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in one to three regional lymph nodes
N2	Metastasis in four or more regional lymph nodes
Distant metastasis (M)
M category	M criteria
M0	No distant metastasis
M1	Distant metastasis
Prognostic stage groups
When T is...	And N is...	And M is...	Then the stage group is...
Tis	N0	M0	0
T1	N0	M0	IA
T1	N1	M0	IIB
T1	N2	M0	III
T2	N0	M0	IB
T2	N1	M0	IIB
T2	N2	M0	III
T3	N0	M0	IIA
T3	N1	M0	IIB
T3	N2	M0	III
T4	Any N	M0	III
Any T	Any N	M1	IV

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TNM: tumor, node, metastasis; AJCC: American Joint Committee on Cancer; UICC: Union for International Cancer Control.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing.

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7판과 비교하여 8판은 T stages 정의에 두드러진 변화가 있습니다. 이 변화는 primary tumor 크기와 관련 (전이) LN 수에 따른 전체 생존률 사이를 입증한 데이터에 근거합니다.

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Survival according to T category and the number of positive nodes for patients undergoing resection of exocrine pancreatic cancer, stratified according to the revised AJCC 8th edition TNM staging criteria

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8판 prognostic stage groupings에 따른 resected pancreatic cancer의 survival curves는 8960명 환자들을 대상으로 한 Surveillance, Epidemiology, and End Results (SEER) database 분석에 따른 것으로 stage IA, IB, IIA, IIB, III 환자에서 평균 생존기간은 각각 38, 24, 18, 17, 14 개월이었습니다.

Predicted overall survival for patients with resected pancreatic cancer according to the eighth edition (2017) American Joint Committee on Cancer (AJCC) prognostic stage groups

The eighth edition AJCC Staging System predicts overall survival for patients with resected pancreas cancer and indicates the corresponding number of patients at risk.

Reprinted by permission from: Springer: Annals of Surgical Oncology. Kamarajah SK, Burns WR, Frankel TL, et al. Validation of the American Joint Commission on Cancer (AJCC) 8th Edition Staging System for Patients with Pancreatic Adenocarcinoma: A Surveillance,

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유사한 결과가 1525명의 resected pancreatic cancer 환자를 대상으로 한 international validation cohort에서 기술되었습니다. Stage grouping에 따른 5년 생존률은 다음과 같습니다.

● Stage IA – 39 percent

● Stage IB – 34 percent

● Stage IIA – 28 percent

● Stage IIB – 21 percent

● Stage III – 11 percent​

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Staging workup의 목표는 질병 진행 (전이) 정도를 기술하고 치료 목적으로 절제 할 수있는 환자를 확인하는 것입니다.

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REF. UpToDate 2020.09.01