Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer

IF 1.7 Q3 SURGERY

Surgery open science Pub Date : 2026-03-01 Epub Date: 2026-01-19 DOI:10.1016/j.sopen.2026.01.002

Axel Bengtsson MD, Roland Andersson MD, PhD, Bodil Andersson MD, PhD, Daniel Ansari MD, PhD

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Abstract

Background

Pancreatic ductal adenocarcinoma (PDAC) is characterized by a prominent desmoplastic stroma, which plays a crucial role in tumor biology and treatment resistance. While the stromal compartment is a defining histopathological feature of PDAC, its prognostic significance remains incompletely understood. This study aimed to quantify the stromal content in PDAC using digital pathology and evaluate its association with patient outcomes.

Methods

Tissue microarrays (TMAs) were constructed from resected PDAC specimens (n = 142). Digital analysis of tumor stroma percentage (TSP) was performed on tissue sections labeled with CA19–9. Cases were stratified into low and high TSP groups based on an optimized threshold of 44.2%. Associations between TSP and clinicopathological variables were assessed, and survival outcomes were analyzed using Kaplan-Meier and Cox proportional hazards models.

Results

Digital quantification revealed wide intertumoral variability in TSP. A total of 127 (89%) patients were categorized into the high TSP group (>44.2% stroma). A high TSP was significantly associated with anatomic location of the tumor in the head of the pancreas. Patients with high TSP exhibited significantly prolonged overall survival (median: 27.8 months vs 12 months, p < 0.001). In multivariable analysis, high TSP remained an independent predictor of favorable prognosis (HR = 0.26, 95% CI: 0.13–0.52, p < 0.001).

Conclusion

A high TSP is independently associated with improved survival in PDAC. These findings challenge traditional views of the stroma as purely tumor-promoting and suggest a potential protective role of the stromal compartment in certain contexts.

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数字量化间质百分比可提高胰腺癌的预后分层

胰腺导管腺癌（pancreatic ductal adencarcinoma， PDAC）的特点是具有显著的间质增生，在肿瘤生物学和治疗耐药性中起着至关重要的作用。虽然间质室是PDAC的组织病理学特征，但其预后意义仍不完全清楚。本研究旨在利用数字病理学量化PDAC基质含量，并评估其与患者预后的关系。方法利用142例PDAC切除标本构建组织微阵列（tma）。在CA19-9标记的组织切片上进行肿瘤间质百分比（TSP）的数字分析。以44.2%为优化阈值，将病例分为高、低TSP组。评估TSP与临床病理变量之间的关系，并使用Kaplan-Meier和Cox比例风险模型分析生存结果。结果数字量化显示TSP在肿瘤间具有广泛的差异性。高TSP组127例（89%）（44.2%）。高TSP与肿瘤在胰腺头部的解剖位置显著相关。高TSP患者的总生存期明显延长（中位：27.8个月vs 12个月，p < 0.001）。在多变量分析中，高TSP仍然是良好预后的独立预测因子（HR = 0.26, 95% CI: 0.13-0.52, p < 0.001）。结论高TSP与PDAC患者生存率的提高独立相关。这些发现挑战了传统的观点，即基质纯粹是促进肿瘤的，并表明基质室在某些情况下具有潜在的保护作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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