Medical oncology
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Previous studies of pancreatic ductal adenocarcinoma (PDAC) have demonstrated that the addition of tumor grade to the 7th American Joint Committee on Cancer (AJCC) staging can provide improved prognostication and that the recently proposed 8th edition AJCC staging exhibited superior reproducibility to the 7th edition in resectable PDAC. Thus, we aimed to combine tumor grade and 8th AJCC stage to develop a refined staging scheme for resectable PDAC. We analyzed 7719 patients with resectable PDAC from the 2004-2012 Surveillance, Epidemiology, and End Results database. ⋯ The RPA staging outperformed the 8th AJCC classifications in terms of discrimination (concordance index, 0.585 versus 0.565; P < 0.001) and prognostic homogeneity. Tumor grade can provide additional prognostic information to the 8th AJCC staging. The proposed RPA staging is a superior risk-stratified tool to the 8th AJCC staging and is not substantially more complex.