Tianjin grading system improves prognosis prediction in pancreatic cancer

Pancreatic ductal adenocarcinoma (PDAC) is notoriously difficult to treat due to its aggressive nature and limited prognostic tools. While the traditional staging systems, such as the TNM classification, focus on anatomical factors, they fall short in providing a comprehensive prognosis. The Tianjin Grading System addresses this gap by integrating anatomical, biological, and patient condition factors. Developed using a cohort of Chinese patients, this new grading system refines patient risk stratification by incorporating crucial factors like lymph node metastasis and CA19-9 levels, offering a more holistic approach to managing PDAC. Based on these challenges, there is a need for deeper research into integrating biological markers into preoperative assessments.

Published (DOI: 10.20892/j.issn.2095-3941.2025.0213)in Cancer Biology & Medicine in 2025, the Tianjin Grading System, developed by Tianjin Medical University Cancer Institute & Hospital, combines anatomical and biological data to predict patient survival more effectively than traditional staging methods. The study highlights how integrating tumor resectability, imaging-detected lymph node metastasis, serum markers like CA19-9, and nutritional status into a single grading system can significantly improve clinical decision-making. This multi-dimensional approach provides a more accurate prognosis, allowing for better-tailored treatment strategies and ultimately improving patient outcomes.

The Tianjin Grading System was developed through a retrospective study involving 687 PDAC patients who underwent surgical resection. By analyzing factors like resectability status, serum CA19-9 levels, lymph node metastasis, and the Prognostic Nutritional Score (PNS), researchers were able to identify independent prognostic factors influencing overall survival (OS) and disease-free survival (DFS). The patients were categorized into four distinct risk groups: low-risk (0-1), intermediate-risk (2-3), high-risk (4-5), and extremely high-risk (6-10), with significantly divergent survival outcomes for each group. Notably, patients in the high- and extremely high-risk categories benefited greatly from neoadjuvant chemotherapy (NAC). The Tianjin system outperformed traditional methods like serum CA19-9 and anatomical resectability in predicting patient survival. These findings underscore the importance of a multi-dimensional approach to assessing PDAC, improving the ability to guide treatment strategies and personalize care.

Dr. Jihui Hao, one of the lead researchers, commented, "The Tianjin Grading System offers a more accurate way of predicting outcomes for PDAC patients by integrating not just anatomical factors but also biological and patient-specific conditions. This system helps us better understand which patients will benefit most from aggressive treatments like neoadjuvant chemotherapy, paving the way for more personalized, effective care strategies."

The Tianjin Grading System has significant implications for improving clinical decision-making in PDAC treatment. By providing a more accurate prognosis, it can guide when patients should undergo upfront surgery or receive NAC. This comprehensive assessment also helps healthcare providers tailor treatment plans, improving survival rates for high-risk patients and ensuring that low-risk patients are not overtreated. The system's accessibility—using standard imaging and laboratory tests—makes it a practical tool for diverse clinical settings, including those with limited resources, offering a new standard in personalized pancreatic cancer care.