Metro-Pancreas stratifies survival after neoadjuvant therapy for resectable pancreatic cancer

Researchers analyzed 623 patients with nonmetastatic, anatomically resectable pancreatic ductal adenocarcinoma who received neoadjuvant chemotherapy followed by resection at five institutions between 2016 and 2024. The Metro-Pancreas framework classifies patients as IN or OUT using tumor size and CA 19-9 levels. The study assessed postoperative disease-free survival (DFS) and overall survival (OS), including after restaging following chemotherapy.

At diagnosis, 263 patients (42.2%) were classified as OUT. Their median DFS was 13.3 months versus 16.7 months for IN patients, and median OS was 29.5 versus 34.8 months. After chemotherapy, 71.9% of initially OUT patients were reclassified as IN, while 5.0% of initially IN patients became OUT. At restaging, survival differences were larger: DFS was 7.7 versus 17.3 months and OS was 15.8 versus 36.7 months. Patients moving from OUT to IN had DFS and OS comparable to those initially classified as IN.

The findings suggest the framework may help stratify prognosis dynamically in patients proceeding to surgery after neoadjuvant treatment. This retrospective analysis included only patients who underwent resection, so it does not establish that classification should guide treatment decisions or apply to patients who do not reach surgery.