The PANEN nomogram, built from 447 pancreatic NET patients receiving PRRT, predicts overall survival with a test c-index of 0.82 using 17 clinical, imaging, and pathological variables.
C-index 0.8217-variable nomogram built from 447 PRRT patients accurately predicts pancreatic NET survival to guide treatment decisions
What the researchers found
17 independent OS predictors identified. Top predictors: time to PRRT, alkaline phosphatase, KPS, hepatomegaly, weight loss, FDG-PET positivity, Ki-67 grade. C-index: 0.86 (development), 0.82 (test). Median follow-up: 2045 days.
Why it matters
PRRT is expensive and involves radiation. Having a validated prediction tool helps clinicians identify which patients are most likely to benefit, optimizing treatment selection and enabling better-informed patient counseling.
How the study worked
Retrospective analysis of 447 pancreatic NEN patients treated with PRRT. Random survival forests (RSF) modeling. 80/20 train/test split. Internal validation. Nomogram construction.
What this study cannot tell us
Single-center retrospective data. Internal validation only—external validation needed. RSF models can be less interpretable than traditional regression. Not all variables may be available at all centers.
How to read the evidence
Large retrospective study with good ML methodology and internal validation. External validation needed for clinical implementation.
When this study was published
Published in 2025.
The bigger picture
As personalized medicine advances in oncology, prediction tools like the PANEN nomogram bridge the gap between population-level trial data and individual patient decision-making. This is the largest PRRT prediction study for pancreatic NETs.
Questions still open
- Will external validation in other centers confirm the nomogram's accuracy?
- Can the model be integrated into electronic health record systems for real-time decision support?
- Should PRRT be withheld from patients with poor nomogram scores?
Common questions
What is the PANEN nomogram?
How accurate is it?
Read the original research
The PANEN nomogram: clinical decision support for patients with metastatic pancreatic neuroendocrine neoplasm referred for peptide receptor radionuclide therapy.
Frontiers in endocrinology, 16, 1514792
Citation
Singh, Aviral; Sanduleanu, Sebastian; Kulkarni, Harshad R; Langbein, Thomas; Lambin, Philippe; Baum, Richard P. (2025). The PANEN nomogram: clinical decision support for patients with metastatic pancreatic neuroendocrine neoplasm referred for peptide receptor radionuclide therapy.. Frontiers in endocrinology, 16, 1514792. https://doi.org/10.3389/fendo.2025.1514792