The PAN-SUR(IN) score for advanced pancreatic cancer: A comprehensive analysis of methodology, prognostic derivation, and clinical risk stratification.

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Background: Pancreatic ductal adenocarcinoma (PDAC) is characterized by late presentation and aggressive biology. However, outcomes in unresectable or metastatic disease vary widely, ranging from rapid decline to survival exceeding one year. Standard staging systems often fail to account for this granularity. We developed and validated the "PAN-SUR Score," a novel tool based on real-world data to stratify survival risk in advanced PDAC. Methods: A retrospective cohort analysis was conducted on 197 patients with unresectable locally advanced or metastatic PDAC at Surin Hospital, Thailand. Independent predictors of overall survival (OS) were identified using a multivariable flexible parametric survival model. Weighted integer scores were assigned based on beta coefficients. Model discrimination was benchmarked using Harrell’s Concordance Index (C-index) and time-dependent Area Under the Curve (AUC). Results: Five independent prognostic factors were identified: lack of first-line chemotherapy (3 points; aHR 3.71), liver metastasis (1.5 points; aHR 2.00), tumor location (uncinate process [1.5] or head/tail [1] vs. body [0]), BMI <18.0 kg/m² (1 point; aHR 1.64), and initial CA 19-9 ≥1,000 U/mL (1 point; aHR 1.54). The PAN-SUR score demonstrated robust discrimination (C-index 0.718; 6-month AUC 0.86) and stratified patients into three distinct risk groups with significantly divergent median OS: Low-Risk (11.2 months), Intermediate-Risk (5.1 months), and High-Risk (2.3 months). Conclusions: The PAN-SUR score is a practical, objective tool utilizing readily available clinical data. By integrating functional status, tumor biology, and treatment history, it effectively identifies candidates for aggressive therapy versus best supportive care, addressing a critical need for personalized risk assessment in resource-constrained settings.

Risk stratification, survival outcomes, and clinical performance of the PAN-SUR score in the derivation cohort.