Validation of the PANAMA Score in Patients With Pancreatic Ductal Adenocarcinoma Undergoing Distal Pancreatectomy

ABSTRACT 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.