A novel scoring system for prognostic stratification of node-positive pancreatic ductal adenocarcinoma

Stage IIB or III pancreatic ductal adenocarcinoma (PDAC) includes patients with varying tumor sizes and numbers of nodal metastases. This study aimed to stratify the prognoses of patients with stage IIB and III PDACs by tumor size and number of nodal metastases.

This study included patients who underwent pancreatectomy for node-positive stage IIB or III PDAC between January 2006 and December 2021. Our "tumor score" was obtained by multiplying tumor size by the number of nodal metastases, and patients were divided into low- and high-scoring groups based on the cutoff value determined by the minimum P value approach to predict worse overall survival (OS).

Overall, 416 patients were included in the study. The best cutoff tumor score was 70. The median OS estimates of the low-scoring (n = 166) and high-scoring (n = 250) groups were 32.4 and 19.4 months, respectively (P <.001). Multivariate analysis revealed that a high score was an independent prognostic factor for OS. Patients with stage IIB disease were divided into low-scoring (IIB_low, n = 166) and high-scoring (IIB_high, n = 71) groups. The median OS was significantly different between the stage IIB_low and stage IIB_high groups (32.4 vs 18.5 months, respectively; P =.001). However, there was no significant difference between the stage IIB_high and stage III groups (n = 179; 19.4 months) (P =.372).

This study proposed a novel tumor scoring system for PDAC. Patients with higher tumor scores should be distinguished from those with lower tumor scores.