Most Patients With Stage I PDAC Are Upstaged on Histopathology

MONDAY, Sept. 9, 2024 (HealthDay News) — More than 70 percent of patients with stage I pancreatic ductal adenocarcinoma (PDAC) and close to 30 percent with stage II PDAC are upstaged on histopathology, according to a research letter published online Sept. 5 in the Journal of the American Medical Association.

Gerardo Perrotta, M.D., from Cedars-Sinai Medical Center in Los Angeles, and colleagues examined the accuracy of clinical staging in early-stage PDAC. The study included all patients with clinical stage I and II PDAC from the National Cancer Database who underwent surgical resection between 2004 and 2020; complete data were available for 24,260 patients with stage I PDAC and 23,850 patients with stage II PDAC. When pathologic stage, obtained at surgery, was higher than clinical stage, patients were considered upstaged.

The researchers found that 88 and 12 percent of patients with clinical stage I PDAC underwent up-front surgical resection (USR) and neoadjuvant therapy followed by surgical resection (NTSR), respectively. Overall, 79.1 and 73.5 percent of those in the USR and NTSR groups, respectively, were upstaged. For patients with clinical stage II PDAC, 75 and 25 percent underwent USR and NTSR, respectively. In the USR and NTSR groups, 30.1 and 28.7 percent were upstaged, respectively. The results were similar in the analysis stratified by year of diagnosis.

“These findings have implications for risk stratification and treatment selection,” the authors write. “Better imaging modalities and protocols for lymph node evaluation should be implemented.”

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