ANZ journal of surgery · 2026
Validation of the PANAMA Score in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Distal Pancreatectomy.
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Li Simeng, Masuda Hiro, Kotecha Krishna, Bhimani Nazim, Pavlakis Nick, Clarke Stephen, Chou Angela, Gill Anthony, Brown Kai, Samra Jaswinder, Mittal Anubhav
Аннотация
BACKGROUND: The PANAMA score was developed as a post-NAT prognostic tool for PDAC. Prior validations have been dominated by pancreatic head cancers. Pancreatic body and tail tumours represent a biologically distinct subgroup and remain underrepresented in NAT cohorts. Whether the score reliably predicts outcomes in distal PDAC remains unknown.
METHODS: A retrospective study was conducted at a single centre including patients with PDAC who received NAT followed by distal pancreatectomy between January 2015 and December 2024. Patients were stratified into low-, intermediate- and high-risk groups based on the original PANAMA score. Overall survival (OS) and disease-free survival (DFS) were assessed. Prognostic performance of the PANAMA score and AJCC staging was compared.
RESULTS: Fifty-two patients were included. Median OS and DFS were 40.8 months (95% CI: 28.7-55.0) and 11.6 months (95% CI: 9.7-14.5), respectively. High-risk patients showed worse OS compared to intermediate- and low-risk groups (21.8, 31.1 and 55.0 months, respectively, p = 0.009). A similar pattern was observed for DFS (10.3, 11.2 and 29.2 months, respectively, p = 0.029). The AJCC stage outperformed the PANAMA score in OS prediction (C-index 0.70 vs. 0.64).
CONCLUSION: The PANAMA score effectively stratifies patients with pancreatic body and tail PDACs undergoing neoadjuvant therapy and resection into prognostic groups.
METHODS: A retrospective study was conducted at a single centre including patients with PDAC who received NAT followed by distal pancreatectomy between January 2015 and December 2024. Patients were stratified into low-, intermediate- and high-risk groups based on the original PANAMA score. Overall survival (OS) and disease-free survival (DFS) were assessed. Prognostic performance of the PANAMA score and AJCC staging was compared.
RESULTS: Fifty-two patients were included. Median OS and DFS were 40.8 months (95% CI: 28.7-55.0) and 11.6 months (95% CI: 9.7-14.5), respectively. High-risk patients showed worse OS compared to intermediate- and low-risk groups (21.8, 31.1 and 55.0 months, respectively, p = 0.009). A similar pattern was observed for DFS (10.3, 11.2 and 29.2 months, respectively, p = 0.029). The AJCC stage outperformed the PANAMA score in OS prediction (C-index 0.70 vs. 0.64).
CONCLUSION: The PANAMA score effectively stratifies patients with pancreatic body and tail PDACs undergoing neoadjuvant therapy and resection into prognostic groups.