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Validation of the PANAMA Score for Survival and Benefit of Adjuvant Therapy in Patients With Resected Pancreatic Cancer after Neoadjuvant FOLFIRINOX
IF. Rompen, TF. Stoop, S. van Roessel, E. van Veldhuisen, QP. Janssen, A. Alseidi, A. Balduzzi, G. Balzano, F. Berrevoet, M. Bonds, OR. Busch, G. Butturini, AA. Javed, M. Del Chiaro, KC. Conlon, M. Falconi, I. Frigerio, GK. Fusai, J. Gagnière, O....
Language English Country United States
Document type Journal Article, Multicenter Study, Validation Study
- MeSH
- Chemotherapy, Adjuvant MeSH
- Adult MeSH
- Carcinoma, Pancreatic Ductal * mortality therapy drug therapy surgery MeSH
- Fluorouracil therapeutic use MeSH
- Risk Assessment MeSH
- Irinotecan therapeutic use MeSH
- Leucovorin therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Pancreatic Neoplasms * mortality therapy drug therapy surgery MeSH
- Neoadjuvant Therapy MeSH
- Oxaliplatin therapeutic use MeSH
- Pancreatectomy * MeSH
- Prognosis MeSH
- Antineoplastic Combined Chemotherapy Protocols * therapeutic use MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Validation Study MeSH
OBJECTIVE: 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. 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.
Cancer Center Amsterdam Amsterdam The Netherlands
Collegium Medicum University of Social Sciences Lodz Poland
Department of Diagnostics and Intervention Surgery Umeå University Umeå Sweden
Department of Gastroenterological Surgery Helsinki University Hospital Helsinki Finland
Department of Medical Oncology Odense University Hospital Odense Denmark
Department of Pancreatic Surgery IRCCS San Raffaele Hospital Vita Salute University Milano Italy
Department of Surgery Amsterdam UMC location University of Amsterdam Amsterdam The Netherlands
Department of Surgery Charles University and Central Military Hospital Prague Czech Republic
Department of Surgery Erasmus MC Cancer Center Rotterdam The Netherlands
Department of Surgery Odense Pancreas Center Odense University Hospital Odense Denmark
Department of Surgery Oklahoma University Health Science Center Oklahoma City Oklahoma
Department of Surgery Pederzoli Hospital Peschiera Italy
Department of Surgery Trinity College Dublin Trinity Centre for Health Sciences Dublin Ireland
Department of Surgery University Hospital Birmingham Birmingham UK
Department of Surgery University of California at San Francisco San Francisco
Department of Surgery University of Colorado Hospital Aurora
Hepatobiliary Surgery and Liver Transplantation Unit Royal Free Hospital London UK
National Surgical Centre for Pancreatic Cancer St Vincent's University Hospital Dublin Ireland
References provided by Crossref.org
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- $a Validation of the PANAMA Score for Survival and Benefit of Adjuvant Therapy in Patients With Resected Pancreatic Cancer after Neoadjuvant FOLFIRINOX / $c IF. Rompen, TF. Stoop, S. van Roessel, E. van Veldhuisen, QP. Janssen, A. Alseidi, A. Balduzzi, G. Balzano, F. Berrevoet, M. Bonds, OR. Busch, G. Butturini, AA. Javed, M. Del Chiaro, KC. Conlon, M. Falconi, I. Frigerio, GK. Fusai, J. Gagnière, O. Griffin, T. Hackert, E. Sparrelid, A. Halimi, KJ. Labori, G. Malleo, MV. Marino, MB. Mortensen, A. Nikov, M. Lesurtel, T. Keck, J. Kleeff, R. Pandé, P. Pfeiffer, D. Pietrasz, KJ. Roberts, A. Sa Cunha, R. Salvia, O. Strobel, T. Tarvainen, HWM. van Laarhoven, B. Groot Koerkamp, M. Loos, CW. Michalski, MG. Besselink, T. Hank
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- $a OBJECTIVE: 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. 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.
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