System to Improve Clinical Staging in Localized Pancreatic Cancer

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In a Trans-Atlantic Pancreatic Surgery Consortium study reported in the Journal of Clinical Oncology, Dekker et al found that the “ABC” clinical staging system could be used to differentiate overall survival outcomes in patients with localized pancreatic ductal adenocarcinoma.

Study Details

The study included 1,835 patients treated with initial mFOLFIRINOX (modified fluorouracil with leucovorin, irinotecan, and oxaliplatin) at five high-volume pancreatic cancer centers in the United States and the Netherlands between 2012 and 2019. ABC factors are: anatomy (A), consisting of resectable, borderline resectable, or locally advanced disease; biologic (B), consisting of CA 19-9 level; and conditional (C), consisting of World Health Organization (WHO) performance status.

Key Findings

Among the 1,835 patients, tumor stage at diagnosis was potentially resectable in 346 (18.9%), borderline resectable in 531 (28.9%), and locally advanced in 958 (52.2%). Baseline CA 19-9 was > 500 U/mL in 559 patients (32.5%). WHO performance status was ≥ 1 in 1,110 patients (60.7%).

Independent prognostic ABC factors for poorer overall survival were borderline resectable disease (hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.06–1.50), locally advanced disease (HR = 1.71, 95% CI = 1.45–2.02), CA 19-9 > 500 U/mL (HR = 1.36, 95% CI = 1.21–1.52), and WHO performance status ≥ 1 (HR = 1.31, 95% CI = 1.16–1.47).

When patients were assigned 2 points for locally advanced disease and 1 point for each additional poor ABC factor, median overall survival rates for scores of 0, 1, 2, 3, and 4 were 49.7, 29.9, 22.0, 19.1, and 14.9 months, respectively; corresponding 5-year overall survival rates were 47.0%, 28.9%, 19.2%, 9.3%, and 4.8%.

The investigators concluded, “The ABC factors of tumor anatomy, CA 19-9, and performance status at diagnosis were independent prognostic factors for overall survival in patients with localized pancreatic ductal adenocarcinoma treated with initial mFOLFIRINOX. Staging of patients with localized pancreatic ductal adenocarcinoma at diagnosis should be based on anatomy, CA 19-9, and performance status.”

Bas Groot Koerkamp, MD, PhD, of the Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Dutch Cancer Society and ZonMw. For full disclosures of the study authors, visit

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