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Tumor-stroma ratio combined with PD-L1 identifies pancreatic ductal adenocarcinoma patients at risk for lymph node

Xianlong Chen1, Shanyue Sun2, Jiapeng Zhao3

  • 1Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.

British Journal of Cancer
|April 17, 2025
PubMed
Summary
This summary is machine-generated.

The tumor-stroma ratio (TSR) effectively predicts lymph node metastasis (LNM) in pancreatic ductal adenocarcinoma (PDAC). This biomarker aids in identifying patients for tailored treatment strategies.

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Area of Science:

  • Oncology
  • Pathology
  • Cancer Biomarkers

Background:

  • Lymph node metastasis (LNM) is critical for pancreatic ductal adenocarcinoma (PDAC) treatment.
  • The prognostic role of tumor stroma in PDAC LNM detection remains unclear.

Purpose of the Study:

  • Investigate the association of tumor-stroma ratio (TSR) with LNM in PDAC.
  • Evaluate TSR's correlation with patient survival and mutational profiles.

Main Methods:

  • Retrospective analysis of 737 PDAC patients across 5 cohorts.
  • TSR evaluated on H&E slides; classified as stroma-low (<50%) or stroma-high (≥50%).
  • Included surgically resected and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) specimens.

Main Results:

  • TSR-low cases significantly correlated with LNM (P < 0.001).
  • TSR demonstrated good accuracy (AUC 0.749) for LNM detection, improved by PD-L1 or CA19-9.
  • TSR accurately predicted LNM in resected tumors, EUS-FNA biopsies, and post-neoadjuvant therapy.

Conclusions:

  • TSR is a reliable biomarker for identifying PDAC patients at risk of LNM.
  • TSR can guide treatment selection and management strategies for PDAC.
  • Findings were reproducible across validation and biopsy cohorts.