What is the role of the Furukawa classification in evaluating pancreatic cancer?

Furukawa Classification in Pancreatic Cancer Evaluation

The Furukawa classification is not mentioned in current clinical practice guidelines for pancreatic cancer evaluation, with the TNM staging system remaining the established standard for evaluating pancreatic cancer according to ESMO-ESDO guidelines. 1

Current Standard Classification Systems for Pancreatic Cancer

TNM Classification

• The established staging system for pancreatic cancer is the TNM classification developed by the AJCC-UICC committee 1
• This system classifies tumors based on:
  • Primary tumor size and extension (T)
  • Regional lymph node involvement (N)
  • Presence of distant metastases (M) 1

Resectability-Based Classification

• A simpler, clinically relevant classification system focuses on resectability status 1:
  • Resectable: Cancer localized to pancreas that can be completely removed surgically
  • Locally advanced (unresectable): Cancer with extensive local invasion preventing complete surgical removal
  • Metastatic: Cancer with spread to distant organs 1

Important Prognostic Factors in Pancreatic Cancer

• Resection margin status is a key prognostic factor, with circumferential resection margin (CRM) requiring specific pathological assessment 1
• The British Royal College of Pathologists recommends considering carcinoma <1mm from resection margin as incompletely excised 1
• Post-resection CA19.9 levels are established prognostic indicators 1
• Tumor size, nodal involvement, and histological grade are strong prognostic factors 1

Emerging Classification Approaches

• Recent research suggests that anatomy alone is insufficient for defining resectability in the current era of effective neoadjuvant treatment 2
• Newer classification systems incorporate:
  • Tumor biology
  • Patient physiology
  • Response to neoadjuvant therapy 3, 2
• Molecular profiling studies have identified distinct subtypes of pancreatic ductal adenocarcinoma with different behaviors and potential therapeutic targets 4, 5

Clinical Evaluation of Pancreatic Cancer

• Multi-detector CT (MD-CT) and MRI with MRCP have the highest sensitivity for detection of pancreatic cancer 1
• Endoscopic ultrasound (EUS) allows biopsy and fine needle aspiration cytology 1
• CA19.9 has limited diagnostic value but can be used to guide treatment and follow-up 1
• Histological proof of malignancy is only mandatory in unresectable cases or when neoadjuvant therapy is planned 1

Treatment Approach

• Radical surgery remains the only curative treatment for pancreatic cancer, primarily suitable for stage I and some stage II patients 1
• Adjuvant chemotherapy with gemcitabine or 5-fluorouracil may be recommended following surgery 1
• The role of chemoradiation remains controversial 1
• For locally advanced or metastatic disease, optimal symptomatic treatment is crucial 1

Clinical Implications

• Accurate staging and classification are essential for determining appropriate treatment strategies and predicting outcomes 1
• The integration of anatomical, biological, and physiological factors may improve patient selection for specific treatment approaches 3, 2
• Pathological classification should carefully distinguish pancreatic ductal adenocarcinoma from other pancreatic neoplasms with different biological behaviors 5