Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer

Bengtsson, Axel LU ; Andersson, Roland LU ; Andersson, Bodil LU orcid and Ansari, Daniel LU (2026) In Surgery Open Science 30. p.8-13
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%.... (More)

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.

(Less)
Please use this url to cite or link to this publication:
author
; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Digital analysis, Pancreatic cancer, Prognosis, Tumor stroma percentage
in
Surgery Open Science
volume
30
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:105027837785
  • pmid:41630854
ISSN
2589-8450
DOI
10.1016/j.sopen.2026.01.002
language
English
LU publication?
yes
id
b6ee2cc9-696c-45d5-9bbc-e1f760cffc85
date added to LUP
2026-02-18 13:30:52
date last changed
2026-02-19 03:00:03
@article{b6ee2cc9-696c-45d5-9bbc-e1f760cffc85,
  abstract     = {{<p>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 (&gt;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 &lt; 0.001). In multivariable analysis, high TSP remained an independent predictor of favorable prognosis (HR = 0.26, 95% CI: 0.13–0.52, p &lt; 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.</p>}},
  author       = {{Bengtsson, Axel and Andersson, Roland and Andersson, Bodil and Ansari, Daniel}},
  issn         = {{2589-8450}},
  keywords     = {{Digital analysis; Pancreatic cancer; Prognosis; Tumor stroma percentage}},
  language     = {{eng}},
  pages        = {{8--13}},
  publisher    = {{Elsevier}},
  series       = {{Surgery Open Science}},
  title        = {{Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer}},
  url          = {{http://dx.doi.org/10.1016/j.sopen.2026.01.002}},
  doi          = {{10.1016/j.sopen.2026.01.002}},
  volume       = {{30}},
  year         = {{2026}},
}