International Journal ofPancreatology, vol. 17,no. 3,279--289, June1995 9 Copyright by Humana Press Inc. Allrights ofany nature whatsoever reserved. 0169-4197/95/17:279-289/$6.20 Prognostic Value of Histological Grading in Ductal Adenocarcinoma of the Pancreas Klb'ppel vs TNM Grading Pier Cristoforo Giulianotti,*,' Ugo Boggi,' Gino Fornaciari, 2Joseph Brunofl Giuseppe Rossifl Demostene Giardino, 1 Giulio Di Candio, 1 and Franco Mosca' qstituto di Chirurgia Generale e Sperimentale, Universit~ degli Studi di Pisa, Ospedale di Cisanello, Pisa, Italy; 2Istituto di Anatomia Patologica, Universit~ degli Studi di Pisa, Ospedale S. Chiara, Pisa, Italy; and 3Unitd di Epidemiologia e Biostatistica, Istituto di Fisiologia Clinica CNR, Pisa, Italy Summary A new histological grading system with prognostic correlation for pancreatic cancer was proposed by K16ppel et al. in 1985. Histological sections from 60 ductal adenocarcinomas operated on between January 1980 and December 1990 were retrospectively reviewed in order to compare K16ppel's grading with standard TNM's grading and assess their prognostic value. K16ppel grading was determined through the following histologic and cytologic factors: number duct-like structures, mucus production, neoplastic epithelium, arrangement and pleomorphism of nuclei, and mitotic activity. A score from 0 (well differentiated) to 2 (poorly differentiated) was given to each factor. The mean value obtained dividing the sum of the different values by the number of parameters was used to construct a malignancy scale and therefore allocate each patient to his K16ppel grading. The concordance index K between the two grading systems was relevant (K = 0.85p < 0.001). There was no relation either between gradings (K16ppel or TNM) and preoperative duration of symptoms or between gradings and UICC stages. TNM' s G2 grades ofmalignancy, N status, and tumor stagewere significantly relatedto survivaltime (p < 0.05). Kl6ppel's grading does not show any advantage over the classical and simpler TNM's grading, even though it can be considered more objective and therefore more easily reproducible. This characteristic further should be enhanced by the introduction of a malignancy scale such as the "mean value." Key Words: Exocrine pancreas; ductal adenocarcinoma; histopathological factors; neoplasm staging; prog- nosis; tumor grading. Introduction Carcinoma of the exocrine pancreas currently ranks fourth as the leading cause of death from malig- nant disease in men and the sixth in women (1). There Received July 19, 1994;Revised January 16, 1995;Accepted January 27, 1995. *Author to whom all correspondence and reprint requests should be addressed: Istituto di Chirurgia Generale e Speri- mentale, Universithdegli Studi di Pisa, Ospedaledi Cisanello, via Paradisa 2, 56124 Pisa, Italy. has been actually only a marginal improvement in the outcome of pancreatic cancer since the beginning of the century (2). Mean survival time after resection varies from 10-20 mo, with a 5-yr survival ofapprox 2% regardless of therapy (3). Despite the existence of several histopathologic classification for ductal adenocarcinoma (4-7), the surgeon is still without any reliable prognostic factor that assists him in identifying and separating that population who may benefit from a radical operation 279