Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Ann Surg. 2022 Feb 1;275(2):391-397. doi: 10.1097/SLA.0000000000004143.
To build a prognostic score for patients with primary chemotherapy undergoing surgery for pancreatic cancer based on pathological parameters and preoperative Carbohydrate antigen 19-9 (CA19-9) levels.
Prognostic stratification after primary chemotherapy for pancreatic cancer is challenging and prediction models, such as the AJCC staging system, lack validation in the setting of preoperative chemotherapy.
Patients with primary chemotherapy resected at the Massachusetts General Hospital between 2007 and 2017 were analyzed. Tumor characteristics independently associated with overall survival were identified and weighted by Cox-proportional regression. The pancreatic neoadjuvant Massachusetts-score (PANAMA-score) was computed from these variables and its performance assessed by Harrel concordance index and area under the receiving characteristics curves analysis. Comparisons were made with the AJCC staging system and external validation was performed in an independent cohort with primary chemotherapy from Heidelberg, Germany.
A total of 216 patients constituted the training cohort. The multivariate analysis demonstrated tumor size, number of positive lymph-nodes, R-status, and high CA19-9 to be independently associated with overall survival. Kaplan-Meier analysis according to low, intermediate, and high PANAMA-score showed good discriminatory power of the new metrics (P < 0.001). The median overall survival for the three risk-groups was 45, 27, and 12 months, respectively. External validation in 258 patients confirmed the prognostic ability of the score and demonstrated better accuracy compared with the AJCC staging system.
The proposed PANAMA-score, based on independent predictors of postresection survival, including pathologic variables and CA19-9, not only provides better discrimination compared to the AJCC staging system, but also identifies patients at high-risk for early death.
基于病理参数和术前糖类抗原 19-9（CA19-9）水平，为接受新辅助化疗后接受手术的胰腺癌患者构建预后评分。
新辅助化疗后胰腺癌的预后分层具有挑战性，预测模型（如 AJCC 分期系统）在新辅助化疗环境中缺乏验证。
分析了 2007 年至 2017 年在马萨诸塞州综合医院接受新辅助化疗并接受手术的患者。通过 Cox 比例风险回归确定与总生存期独立相关的肿瘤特征，并对其进行加权。从这些变量中计算出胰腺新辅助麻省评分（PANAMA 评分），并通过 Harrell 一致性指数和接受特征曲线分析评估其性能。与 AJCC 分期系统进行比较，并在德国海德堡接受新辅助化疗的独立队列中进行外部验证。
共有 216 例患者构成了训练队列。多变量分析表明，肿瘤大小、阳性淋巴结数量、R 状态和高 CA19-9 与总生存期独立相关。根据低、中、高 PANAMA 评分的 Kaplan-Meier 分析显示，新指标具有良好的区分能力（P<0.001）。三个风险组的中位总生存期分别为 45、27 和 12 个月。在 258 例患者中的外部验证证实了评分的预后能力，并与 AJCC 分期系统相比显示出更高的准确性。
基于包括病理变量和 CA19-9 在内的术后生存独立预测因子提出的 PANAMA 评分，不仅与 AJCC 分期系统相比具有更好的区分能力，而且还可以识别出早期死亡风险较高的患者。
