• 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, Sa CunhaAntonioADepartment of Hepato-Biliary-Pancreatic Surgery, Liver Transplant Center, Paul Brousse Hospital, Université Paris-Sud, Université Paris-Saclay, Villejuif, France., Roberto Salvia, Oliver Strobel, Timo Tarvainen, van LaarhovenHanneke W MHWMCancer Center Amsterdam, Amsterdam, the Netherlands.Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, the Netherlands., KoerkampBas GrootBGDepartment of Surgery, Erasmus MC Cancer Center, Rotterdam, the Netherlands., Martin Loos, Christoph Michalski, Marc G Besselink, and Thomas Hank.
• Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
• Ann. Surg. 2025 Jan 31.

AimTo 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.BackgroundThe 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.MethodsThis 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.ResultsOverall, 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).ConclusionsThe 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.Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

13 keywords...

hide…