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Prognostic models are often inaccurate. Our study aimed to improve survival prediction by adding transcriptome\u2010based classification to a validated prognostic model and applying it on a multicenter real\u2010world cohort of fresh\u2010frozen resection materials. RNA was sequenced if tumor cellularity was &gt;\u200930%. The samples were classified using transcriptome\u2010based classification. Survival differences between transcriptome\u2010based subtypes were studied in patients treated with and without adjuvant chemotherapy. 25.6% of the patients received neoadjuvant treatment (NAT). Samples of 461 patients were collected, of which 118 samples underwent RNA sequencing. Of those, 39.0% had a basal\u2010like subtype and 61.0% had a classical subtype. The basal\u2010like subtype became dominant after NAT (63.3%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004). Patients with a classical tumor survived longer than those with a basal\u2010like tumor (median overall survival [OS]: 22.8 vs. 11.4\u2009months;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001, in patients receiving adjuvant gemcitabine, and 10.7 vs. 5.4\u2009months;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.082, in patients without adjuvant treatment). In multivariable Cox regression, the classical subtype significantly associated with increased survival (hazard ratio\u2009=\u20090.38;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002) and adding transcriptome\u2010based subtyping significantly improved the prognostic model (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002). Subtype and adjuvant treatment independently significantly associated with OS. Transcriptome\u2010based subtyping significantly adds to clinical variables in survival prediction after surgery. The independent associations for subtype and adjuvant treatment with OS indicate that subtypes are prognostic, but not predictive for OS with adjuvant treatment. The provided prognostic information could potentially support treatment decisions and serve as stratification factor.\n                  <\/jats:p>","DOI":"10.1002\/ijc.70519","type":"journal-article","created":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T10:41:42Z","timestamp":1777286502000},"page":"1322-1336","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Transcriptome\u2010Based Classification of Resected Pancreatic Ductal Adenocarcinoma Enhances Prognostic Modelling Accuracy of Overall Survival Following Adjuvant Treatment"],"prefix":"10.1002","volume":"159","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0543-0486","authenticated-orcid":false,"given":"Marjolein F.","family":"Lansbergen","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Laboratory of Experimental Oncology and Radiobiology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent R.","family":"Lanting","sequence":"additional","affiliation":[{"name":"Department of Vascular Medicine, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Amsterdam Cardiovascular Sciences  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Manoukian","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Oncology and Radiobiology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G.","family":"Besselink","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"},{"name":"Department of Surgery, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Kazemier","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"},{"name":"Department of Surgery, Amsterdam UMC Vrije Universiteit  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignace H. J. T.","family":"de Hingh","sequence":"additional","affiliation":[{"name":"Department of Surgery Catharina Hospital  Eindhoven the Netherlands"},{"name":"Department of Epidemiology, GROW\u2010School for Oncology and Developmental Biology Maastricht University  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike S. L.","family":"Liem","sequence":"additional","affiliation":[{"name":"Department of Surgery Medisch Spectrum Twente  Enschede the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casper H. J.","family":"van Eijck","sequence":"additional","affiliation":[{"name":"Department of Surgery Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erwin","family":"van der Harst","sequence":"additional","affiliation":[{"name":"Department of Surgery Maasstad Hospital  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent E.","family":"de Meijer","sequence":"additional","affiliation":[{"name":"Department of Surgery University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald M.","family":"van Dam","sequence":"additional","affiliation":[{"name":"Department of Surgery Maastricht University Medical Center  Maastricht the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn W. J.","family":"Stommel","sequence":"additional","affiliation":[{"name":"Department of Surgery Radboud University Medical Center  Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Koster","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Oncology and Radiobiology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W. T.","family":"Tanck","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arantza","family":"Fari\u00f1a Sarasqueta","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"},{"name":"Department of Pathology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Verheij","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"},{"name":"Department of Pathology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederike","family":"Dijk","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"},{"name":"Department of Pathology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna W.","family":"Wilmink","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6627-3229","authenticated-orcid":false,"given":"Maarten F.","family":"Bijlsma","sequence":"additional","affiliation":[{"name":"Laboratory of Experimental Oncology and Radiobiology, Amsterdam UMC University of Amsterdam  Amsterdam the Netherlands"},{"name":"Cancer Center Amsterdam, Imaging and Biomarkers  Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanneke W. 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