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Prognostic Validation of Perineural Invasion Severity Score in Pancreatic Cancer: A Prospective Study
Giulia Gasparini1,2, Stefano Crippa1,2, Marco Schiavo Lena3
1Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Annals of Surgery
|August 26, 2025
Summary
A new perineural invasion (PNI) severity score effectively predicts recurrence and survival in pancreatic cancer patients. This score also identifies patients who benefit most from adjuvant therapy, improving prognostic stratification.
Area of Science:
- Oncology
- Surgical Pathology
- Cancer Prognostics
Background:
- Perineural invasion (PNI) in pancreatic ductal adenocarcinoma (PDAC) exhibits significant heterogeneity.
- A proposed PNI severity score requires prospective validation for clinical utility.
Purpose of the Study:
- To prospectively validate a PNI severity score for predicting recurrence and survival in resected PDAC.
- To assess the score's ability to identify patients who benefit from adjuvant treatment.
Main Methods:
- Prospective study of 300 patients undergoing pancreatectomy (March 2019-February 2022).
- PNI scored as absent (0), mild (<3 mm, 1), or severe (≥3 mm/massive/necrotic, 2).
- Association of PNI severity with disease recurrence and survival analyzed.
Main Results:
- 86% of patients had PNI; 49.3% PNI 1, 36.7% PNI 2.
- PNI severity correlated with poorer pathological features, shorter recurrence (15-24 mo), and survival (32-57 mo).
- PNI 2 independently predicted recurrence (HR 2.082) and survival (HR 3.304); patients with PNI 2 showed improved outcomes with adjuvant therapy.
Conclusions:
- The PNI severity score enhances prognostic stratification for resected PDAC.
- The score identifies patients with PDAC who gain maximal benefit from adjuvant treatment.
