Rompen Ingmar F, Stoop Thomas F, van Roessel Stijn, van Veldhuisen Eran, Janssen Quisette P, Alseidi Adnan, Balduzzi Alberto, Balzano Gianpaolo, Berrevoet Frederik, Bonds Morgan, Busch Olivier R, Butturini Giovanni, Javed Ammar A, Del Chiaro Marco, Conlon Kevin C, Falconi Massimo, Frigerio Isabella, Fusai Giuseppe K, Gagnière Johan, Griffin Oonagh, Hackert Thilo, Sparrelid Ernesto, Halimi Asif, Labori Knut J, Malleo Giuseppe, Marino Marco V, Mortensen Michael B, Nikov Andrej, Lesurtel Mickaël, Keck Tobias, Kleeff Jörg, Pandé Rupaly, Pfeiffer Per, Pietrasz Daniel, Roberts Keith J, Sa Cunha Antonio, Salvia Roberto, Strobel Oliver, Tarvainen Timo, van Laarhoven Hanneke W M, Groot Koerkamp Bas, Loos Martin, Michalski Christoph W, Besselink Marc G, Hank Thomas
Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
Department of Surgery, Amsterdam UMC, location University of Amsterdam, Amsterdam, The Netherlands.
Ann Surg. 2025 May 1;281(5):852-860. doi: 10.1097/SLA.0000000000006650. Epub 2025 Jan 31.
To validate the prognostic value of the PAncreatic NeoAdjuvant MAssachusetts (PANAMA) score and to determine its predictive ability for survival benefit derived from adjuvant treatment in patients after resection of pancreatic ductal adenocarcinoma (PDAC) following neoadjuvant FOLFIRINOX.
The PANAMA score was developed to guide prognostication in patients after neoadjuvant therapy and resection for PDAC. As this score focuses on the risk for residual disease after resection, it might also be able to select patients who benefit from adjuvant after neoadjuvant therapy.
This retrospective international multicenter study is endorsed by the European-African Hepato-Pancreato-Biliary Association. Patients with PDAC who underwent resection after neoadjuvant FOLFIRINOX were included. Mantel-Cox regression with interaction analysis was performed to assess the impact of adjuvant chemotherapy.
Overall, 383 patients after resection of PDAC following neoadjuvant FOLFIRINOX were included of whom 187 (49%), 137 (36%), and 59 (15%) had a low-risk, intermediate-risk, and high-risk PANAMA-score, respectively. Discrimination in median overall survival (OS) was observed stratified by risk groups (48.5, 27.6, and 22.3 months, log-rank Plow-intermediate = 0.004, log-rank Pintermediate-high = 0.027). Adjuvant therapy was not associated with an OS difference in the low-risk group [hazard ratio (HR): 1.50, 95% CI: 0.92-2.50], whereas improved OS was observed in the intermediate (HR: 0.58, 95% CI: 0.34-0.97) and high-risk groups (HR: 0.47, 95% CI: 0.24-0.94; P interaction = 0.008).
The PANAMA 3-tier risk groups (low-risk, intermediate-risk, and high-risk, available through pancreascalculator.com) correspond with differential survival in patients with resected PDAC following neoadjuvant FOLFIRINOX. The risk groups also differentiate between survival benefits associated with adjuvant treatment, with only the intermediate- and high-risk groups associated with improved OS.
验证胰腺新辅助治疗马萨诸塞州（PANAMA）评分的预后价值，并确定其对新辅助FOLFIRINOX治疗后胰腺导管腺癌（PDAC）切除患者辅助治疗生存获益的预测能力。
PANAMA评分旨在指导新辅助治疗和PDAC切除术后患者的预后评估。由于该评分关注切除术后残留疾病的风险，它或许还能够筛选出从新辅助治疗后辅助治疗中获益的患者。
这项回顾性国际多中心研究得到了欧洲-非洲肝胰胆协会的认可。纳入新辅助FOLFIRINOX治疗后接受手术切除的PDAC患者。采用带有交互分析的Mantel-Cox回归来评估辅助化疗的影响。
总体而言，纳入了383例新辅助FOLFIRINOX治疗后切除PDAC的患者，其中187例（49%）、137例（36%）和59例（15%）分别具有低风险、中风险和高风险的PANAMA评分。根据风险组分层观察到中位总生存期（OS）存在差异（48.5、27.6和22.3个月，对数秩检验P低-中=0.004，对数秩检验P中-高=0.027）。辅助治疗与低风险组的OS差异无关[风险比（HR）：1.50，95%置信区间（CI）：0.92-2.50]，而在中风险组（HR：0.58，95%CI：0.34-0.97）和高风险组（HR：0.47，95%CI：0.24-0.94；交互作用P=0.008）观察到OS改善。
PANAMA三级风险组（低风险、中风险和高风险，可通过pancreascalculator.com获取）与新辅助FOLFIRINOX治疗后切除PDAC患者的不同生存期相对应。风险组还区分了与辅助治疗相关的生存获益，只有中风险和高风险组与OS改善相关。
