Article

Impact of Tumor Grade on Prognosis in Pancreatic Cancer: Should We Include Grade in AJCC Staging?

John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, CA, USA.
Annals of Surgical Oncology (Impact Factor: 3.94). 09/2010; 17(9):2312-20. DOI: 10.1245/s10434-010-1071-7
Source: PubMed

ABSTRACT AJCC staging of pancreatic cancer (PAC) is used to determine prognosis, yet survival within each stage shows wide variation and remains unpredictable. We hypothesized that tumor grade might be responsible for some of this variation and that the addition of grade to current AJCC staging would provide improved prognostication.
The Surveillance, Epidemiology, and End Results (SEER) database (1991-2005) was used to identify 8082 patients with resected PAC. The impact of grade on overall and stage-specific survival was assessed using Cox regression analysis. Variables in the model were age, sex, tumor size, lymph node status, and tumor grade.
For each AJCC stage, survival was significantly worse for high-grade versus low-grade tumors. On multivariate analysis, high tumor grade was an independent predictor of survival for the entire cohort (hazard ratio [HR] 1.40, 95% confidence interval [95% CI] 1.31-1.48) as well as for stage I (HR 1.28, 95% CI 1.07-1.54), stage IIA (HR 1.43, 95% CI 1.26-1.61), stage IIB (HR 1.38, 95% CI 1.27-1.50), stage III (HR 1.28, 95% CI 1.02-1.59), and stage IV (HR 1.58, 95% CI 1.21-2.05) patients. The addition of grade to staging results in a statistically significant survival discrimination between all stages.
Tumor grade is an important prognostic variable of survival in PAC. We propose a novel staging system incorporating grade into current AJCC staging for pancreas cancer. The improved prognostication is more reflective of tumor biology and may impact therapy decisions and stratification of future clinical trials.

Download full-text

Full-text

Available from: Nabil Wasif, Oct 05, 2014
0 Followers
 · 
130 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background/Aims: It is very important to determine the prognostic factors for pancreatic adenocarcinoma when choosing surgical and conservative management strategies. In this study, we identified prognostic factors for survival and recurrence in patients with histologically proven pancreatic adenocarcinoma. Methodology: Between January 2003 and December 2009, 82 patients with histologically proven pancreatic adenocarcinoma were considered for this study. Follow-up consisted of personal contact with patients or review of electronic medical records at this center and was terminated on December 31, 2011 or upon the patient's death. Results: Overall survival rates of all patients at 1, 3, and 5 years were 51.9, 21.6 and 16.0%. Preoperative jaundice was the only independent prognostic factor for total pancreatic cancer patients, while N stage and perineural invasion in pathological findings was identified as an independent prognostic factor for survival of patients with surgical resection. Chemotherapy was the only independent prognostic factor for survival of patients who underwent palliative surgical bypass. Conclusions: Preoperative jaundice in any patients, lymph node metastasis, perineural invasion in patients with surgical resection, and chemotherapy in patients undergoing palliative surgical bypass are important prognostic factors for survival of pancreatic cancer.
    Hepato-gastroenterology 03/2013; 60(122):358-62. DOI:10.5754/hge12727 · 0.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A novel current-source active power filter (APF) based on multi-modular converter with carrier phase-shifted SPWM (CPS-SPWM) technique is proposed. With this technique, the effect of equivalent high switching frequency converter is obtained with low switching frequency converter. It is very promising in current-source APF that adopt superconducting magnetic energy storage component.
    Power Electronics and Motion Control Conference, 2004. IPEMC 2004. The 4th International; 09/2004
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The cusp distortion is an inherent behavior of all boost PFC rectifiers. Though the contribution of cusp distortion is small but it limits the maximum achievable performance in PFC rectifier. In spite of this fact, little effort has been made in the past to avoid cusp distortion. We will propose a new topology to minimize the distortion in boost rectifier. The main characteristic of the proposed topology besides improving the distortion in the boost rectifier is that it provides ZCS/ZVS switching of all components except for one hard switching during turn on transient. Furthermore it needs simple output feedback control and requires fewer components; hence it is also economically feasible. For further verification, a prototype system was also built and tested.
    Power Electronics and Motion Control Conference, 2004. IPEMC 2004. The 4th International; 09/2004
Show more