Validation of the PANAMA-Score for Survival and Benefit of Adjuvant Therapy in Patients with Resected Pancreatic Cancer After Neoadjuvant FOLFIRINOX.

IF 7.5 1区医学 Q1 SURGERY

Annals of surgery Pub Date : 2025-01-31 DOI:10.1097/SLA.0000000000006650

Ingmar F Rompen, Thomas F Stoop, Stijn van Roessel, Eran van Veldhuisen, Quisette P Janssen, Adnan Alseidi, Alberto Balduzzi, Gianpaolo Balzano, Frederik Berrevoet, Morgan Bonds, Olivier R Busch, Giovanni Butturini, Ammar A Javed, Marco Del Chiaro, Kevin C Conlon, Massimo Falconi, Isabella Frigerio, Giuseppe K Fusai, Johan Gagnière, Oonagh Griffin, Thilo Hackert, Ernesto Sparrelid, Asif Halimi, Knut J Labori, Giuseppe Malleo, Marco V Marino, Michael B Mortensen, Andrej Nikov, Mickaël Lesurtel, Tobias Keck, Jörg Kleeff, Rupaly Pandé, Per Pfeiffer, Daniel Pietrasz, Keith J Roberts, Antonio Sa Cunha, Roberto Salvia, Oliver Strobel, Timo Tarvainen, Hanneke W M van Laarhoven, Bas Groot Koerkamp, Martin Loos, Christoph Michalski, Marc G Besselink, Thomas Hank

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引用次数: 0

Abstract

Aim: 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.

Background: 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.

Methods: This retrospective international multicenter study is endorsed by the European-African Hepato-Pancreato-Biliary Association (E-AHPBA). 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.

Results: 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. A discrimination in median 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 (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).

Conclusions: The PANAMA 3-tier risk groups (low-risk, intermediate-risk, and high-risk, available via pancreascalculator.com) correspond with differential survival in patients with resected PDAC following neoadjuvant FOLFIRINOX. The risk groups also differentiate between survival benefit associated with adjuvant treatment, with only the intermediate- and high-risk groups associated with improved OS.

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来源期刊

Annals of surgery 医学-外科

CiteScore

14.40

自引率

4.40%

发文量

687

审稿时长

4 months

期刊介绍： The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.