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Two-tier architecture-based grading for pancreatic cancer outperforms traditional grading.
- Source :
-
American journal of clinical pathology [Am J Clin Pathol] 2024 Jul 13. Date of Electronic Publication: 2024 Jul 13. - Publication Year :
- 2024
- Publisher :
- Ahead of Print
-
Abstract
- Objectives: A novel architecture-based grading system for pancreatic ductal adenocarcinoma (PDAC) is tested against traditional grading.<br />Methods: A total of 103 PDAC resections were graded by College of American Pathologists/American Joint Committee on Cancer (CAP/AJCC) guidelines and by a system using an architectural pattern (dispersed larger duct = low grade vs dense smaller duct = high grade). Survival analyses and interobserver variability were assessed. In total, 114 cases from a public data set were used for validation.<br />Results: Median overall survivals were 15 and 36 months for architectural high-grade and low-grade cases, respectively (P < .001). Conversely, CAP/AJCC grading showed no survival difference between well-differentiated and moderately differentiated tumors (P = .545). Architecture-based grading remained prognostically significant for recurrence-free survival (P = .004), but CAP/AJCC grading was not (P = .226). Adjusted for stage and margin status, architectural high-grade PDACs showed a hazard ratio of 2.69 relative to low grade (P < .001) for survival. The validation cohort confirmed prognostic differences in overall (P < .001) and recurrence-free survival (P = .027) for the architecture-based system, outperforming CAP/AJCC grading. Architecture-based grading exhibited a Cohen's ĸ value of 0.710 (substantial agreement), superior to traditional grading (0.488, moderate agreement).<br />Conclusions: Grading PDAC based on architectural pattern results in superior prognostication and reproducibility vs CAP/AJCC grading.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Details
- Language :
- English
- ISSN :
- 1943-7722
- Database :
- MEDLINE
- Journal :
- American journal of clinical pathology
- Publication Type :
- Academic Journal
- Accession number :
- 39001687
- Full Text :
- https://doi.org/10.1093/ajcp/aqae081