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Poorly differentiated clusters surpass tumor budding as novel prognostic factors in pancreatic cancer, especially in cases treated with neoadjuvant chemotherapy
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Poorly differentiated clusters surpass tumor budding as novel prognostic factors in pancreatic cancer, especially in cases treated with neoadjuvant chemotherapy
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Journal Article
Poorly differentiated clusters surpass tumor budding as novel prognostic factors in pancreatic cancer, especially in cases treated with neoadjuvant chemotherapy
2026
Overview
Backgrounds
Poorly differentiated clusters (PDCs), defined as solid cancer nests comprising ≥ 5 cancer cells lacking tubular formation, may reflect the phenotype of epithelial-mesenchymal transition. The diagnostic utility in pathological practice and clinical significance in pancreatic ductal carcinoma (PDAC) has not been fully explored. This study aimed to investigate the presence of PDCs in PDAC and evaluate their clinical implications.
Methods
We examined the presence of PDCs in 102 cases with PDAC. Tumor clusters with ≥ 5 clusters were classified as high PDCs and < 5 were classified as low PDCs. The association of pathological parameters and survival was assessed for high and low PDCs. Subgroup analyses were also performed for 37 cases following neoadjuvant chemotherapy (NAT).
Results
High PDCs were significantly associated with larger tumors, advanced pT category (≥ T3), lymphatic and vascular invasion, positive surgical margins, high tumor budding (TB), elevated CA19-9 levels, and increased recurrence risk (
P
= 0.014, 0.021, 0.011, 0.013, 0.026, < 0.001, 0.016, 0.027, respectively). Moreover, this was associated with worse overall survival and disease-free survival of PDAC, especially in cases following NAT (
P
< 0.001). Additionally, high PDCs in cases following NAT was an independent prognostic factor for shorter overall (Hazard ratio (HR): 9.131,
P
= 0.012) and disease-free survival (HR: 3.896,
P
= 0.018) in multivariable Cox regression analysis, exceeding TB in prognostic impact.
Conclusion
PDCs in the actual pathological diagnosis are more useful as a prognostic marker for PDAC than TB. Due to the limited sample size and broad confidence intervals, the findings of this study should be interpreted with caution and require validation in larger, independent cohorts.
Publisher
BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
Subject
/ Aged
/ Cancer
/ Carcinoma, Pancreatic Ductal - drug therapy
/ Carcinoma, Pancreatic Ductal - mortality
/ Carcinoma, Pancreatic Ductal - pathology
/ Female
/ Humans
/ Male
/ Medicine
/ Pancreatic Neoplasms - drug therapy
/ Pancreatic Neoplasms - mortality
/ Pancreatic Neoplasms - pathology
/ Poorly differentiated cluster
/ Tumors
