Early Pancreatic Cancer Staging Found Inaccurate 80% of the Time: Finds JAMA Study
Staging of patients with early pancreatic cancer is inaccurate as much as 80% of the time, according to a new study published in the peer-reviewed journal JAMA. The finding underscores the urgent need for advancements in diagnostic technology and staging, which could significantly alter early pancreatic cancer treatment and research.
In this study, investigators looked at data from more than 48,000 patients in the National Cancer Database. Based on preoperative imaging, all of the patients in the study had either stage 1 or stage 2 pancreatic cancer.
Following surgery to remove their tumours, more than 78% of stage 1 patients and more than 29% of stage 2 patients were upstaged generally to a stage that includes lymph node involvement.
“Our research reveals that staging essential for making treatment decisions and determining research eligibility is often inaccurate in early-stage pancreatic cancer,” said Srinivas Gaddam, MD, associate director of Pancreatic Biliary Research at Cedars-Sinai and senior author of the study. “As the field is racing toward earlier diagnosis, early staging will become increasingly important.”
Diagnosis and staging of pancreatic cancer are difficult for the same reason. The pancreas, a digestive organ, is located deep in the body and current imaging technology isn’t always able to detect smaller tumours or lymph node involvement, said Gaddam, who is also an associate professor of Medicine and runs the Pancreatic Cancer Screening and Early Detection Program at Cedars-Sinai.
Lymph nodes, clusters of small immune structures, are an important factor in cancer staging and a key difference between early-stage and later-stage pancreatic cancer.
“Patients who have lymph node involvement have a worse survival rate than those without lymph node involvement,” Gaddam said. “When imaging is unable to detect lymph node involvement, staging may not reflect the true extent of the disease. Our findings suggest that lymph node involvement is being missed in four out of every five patients during the staging process.”
The five-year survival rate for stage 1 pancreatic cancer is more than 83%, but that drops to just 3% for patients with stage 4 disease which is when most patients are currently diagnosed.
Reference: Perrotta G, Mohamed G, Larson BK, et al. Accuracy of Clinical Staging in Early-Stage Pancreatic Ductal Adenocarcinoma. JAMA. Published online September 05, 2024. doi:10.1001/jama.2024.16332
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