一种基于架构的新型胰腺导管腺癌 (PDAC) 分级系统与传统分级进行了测试。美国病理学家学会/美国癌症联合委员会 (CAP/AJCC) 指南和系统对总共 103 个 PDAC 切除进行了分级建筑模式（分散的较大管道 = 低等级 vs 密集的较小管道 = 高等级）。评估了生存分析和观察者间的变异性。总共使用公共数据集中的 114 个病例进行验证。建筑高级和低级病例的中位总生存期分别为 15 个月和 36 个月 (P < .001)。相反，CAP/AJCC 分级显示高分化和中分化肿瘤之间的生存率没有差异 (P = .545)。基于架构的分级对于无复发生存仍具有预后意义 (P = .004)，但 CAP/AJCC 分级则不然 (P = .226)。根据阶段和边缘状态进行调整后，架构高级 PDAC 相对于低级 PDAC 的生存风险比为 2.69 (P < .001)。验证队列证实了基于架构的系统在总体 (P < .001) 和无复发生存 (P = .027) 方面的预后差异，优于 CAP/AJCC 分级。基于架构的评分的 Cohen's ĸ 值为 0.710（基本一致），优于传统评分（0.488，中等一致）。与 CAP/AJCC 评分相比，基于架构模式对 PDAC 进行评分可带来更出色的预测和再现性。© 作者）2024 年。由牛津大学出版社代表美国临床病理学会出版。版权所有。如需商业重复使用，请联系 reprints@oup.com 获取转载和转载的翻译权。所有其他权限都可以通过我们网站文章页面上的权限链接通过我们的 RightsLink 服务获得 - 如需了解更多信息，请联系journals.permissions@oup.com。

A novel architecture-based grading system for pancreatic ductal adenocarcinoma (PDAC) is tested against traditional grading.A total of 103 PDAC resections were graded by College of American Pathologists/American Joint Committee on Cancer (CAP/AJCC) guidelines and by a system using an architectural pattern (dispersed larger duct = low grade vs dense smaller duct = high grade). Survival analyses and interobserver variability were assessed. In total, 114 cases from a public data set were used for validation.Median overall survivals were 15 and 36 months for architectural high-grade and low-grade cases, respectively (P < .001). Conversely, CAP/AJCC grading showed no survival difference between well-differentiated and moderately differentiated tumors (P = .545). Architecture-based grading remained prognostically significant for recurrence-free survival (P = .004), but CAP/AJCC grading was not (P = .226). Adjusted for stage and margin status, architectural high-grade PDACs showed a hazard ratio of 2.69 relative to low grade (P < .001) for survival. The validation cohort confirmed prognostic differences in overall (P < .001) and recurrence-free survival (P = .027) for the architecture-based system, outperforming CAP/AJCC grading. Architecture-based grading exhibited a Cohen's ĸ value of 0.710 (substantial agreement), superior to traditional grading (0.488, moderate agreement).Grading PDAC based on architectural pattern results in superior prognostication and reproducibility vs CAP/AJCC grading.© The Author(s) 2024. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.