Validation of the PANAMA Score for Survival and Benefit of Adjuvant Therapy in Patients With Resected Pancreatic Cancer after Neoadjuvant FOLFIRINOX.
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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
Аннотация
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. 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. 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).
CONCLUSIONS: 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.