Confusion by frequent changes in staging of exocrine pancreatic carcinoma

The TNM/pTNM classification of anatomic extent before treatment is the strongest predictor of outcome in exocrine pancreatic carcinoma. Frequent changes in staging, published by the UICC in 1987, 1997, and 2002, lead to considerable problems.

The data on 272 patients with resection of a pancreatic ductal adenocarcinoma between 1978 and 1997 were analyzed.

Two hundred sixty-five tumors were assigned to a higher pT category in 1997. Of them, 70 were reassigned to a lower pT category in 2002. No patient fulfilled the criteria of pT4 in 2002. Eighty-seven tumors were assigned to a higher pathologic stage in 1997. In 2002, 151 tumors were assigned to a lower pathologic stage. No patient was assigned to pathologic stage III. The staging systems of 1987 and 1997 are able to identify subgroups of patients with superior prognosis. The staging system of 2002 includes the same 12 patients in stage I as the classification of 1997. However, stage II contains an inhomogeneous group of 193 patients with poor prognosis.

Changes in the TNM classification require a conversion of the data. Analysis and comparison of published results are very difficult and sometimes impossible if classification systems change too often. The present classification is well qualified for treatment choice and gives good information on prognosis after resection. It should be unchanged for at least 10 years.