{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T03:38:18Z","timestamp":1793158698909,"version":"4.5.0"},"reference-count":40,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Vetenskapsr\u00e5det","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018740","name":"Anna-Greta Crafoord's Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100018740","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003173","name":"Crafoordska Stiftelsen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003173","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002794","name":"Cancerfonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100009780","name":"Region Sk\u00e5ne","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100009780","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","surgopensci.org","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Surgery Open Science"],"published-print":{"date-parts":[[2026,3]]},"DOI":"10.1016\/j.sopen.2026.01.002","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T16:46:19Z","timestamp":1768841179000},"page":"8-13","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer"],"prefix":"10.1016","volume":"30","author":[{"given":"Axel","family":"Bengtsson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bodil","family":"Andersson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Ansari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.sopen.2026.01.002_bb0005","first-page":"10","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J Clin"},{"key":"10.1016\/j.sopen.2026.01.002_bb0010","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S1470-2045(23)00516-8","article-title":"Treatment of metastatic pancreatic cancer: 25 years of innovation with little progress for patients","volume":"25","author":"Gyawali","year":"2024","journal-title":"Lancet Oncol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0015","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1038\/s41575-020-0300-1","article-title":"Pancreatic cancer stroma: an update on therapeutic targeting strategies","volume":"17","author":"Hosein","year":"2020","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0020","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1080\/00365521.2017.1293726","article-title":"Pancreatic cancer stroma: controversies and current insights","volume":"52","author":"Ansari","year":"2017","journal-title":"Scand J Gastroenterol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0025","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1016\/j.ccr.2014.04.021","article-title":"Stromal elements act to restrain, rather than support, pancreatic ductal adenocarcinoma","volume":"25","author":"Rhim","year":"2014","journal-title":"Cancer Cell"},{"key":"10.1016\/j.sopen.2026.01.002_bb0030","doi-asserted-by":"crossref","first-page":"4704","DOI":"10.1172\/JCI136760","article-title":"Pancreatic ductal adenocarcinoma progression is restrained by stromal matrix","volume":"130","author":"Jiang","year":"2020","journal-title":"J Clin Invest"},{"key":"10.1016\/j.sopen.2026.01.002_bb0035","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2021.751311","article-title":"The PDAC extracellular matrix: a review of the ECM protein composition, tumor cell interaction, and therapeutic strategies","volume":"11","author":"Perez","year":"2021","journal-title":"Front Oncol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0040","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1158\/2159-8290.CD-22-0876","article-title":"Context-specific determinants of the immunosuppressive tumor microenvironment in pancreatic Cancer","volume":"13","author":"Falcomat\u00e0","year":"2023","journal-title":"Cancer Discov"},{"key":"10.1016\/j.sopen.2026.01.002_bb0045","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1016\/j.pan.2016.05.393","article-title":"Pancreatic stellate cells regulate blood vessel density in the stroma of pancreatic ductal adenocarcinoma","volume":"16","author":"Di Maggio","year":"2016","journal-title":"Pancreatology"},{"key":"10.1016\/j.sopen.2026.01.002_bb0050","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1111\/hpb.12334","article-title":"The prognostic value of stroma in pancreatic cancer in patients receiving adjuvant therapy","volume":"17","author":"Bever","year":"2015","journal-title":"HPB (Oxford)"},{"key":"10.1016\/j.sopen.2026.01.002_bb0055","doi-asserted-by":"crossref","DOI":"10.1016\/j.ebiom.2021.103269","article-title":"The prognostic impact of the tumour stroma fraction: a machine learning-based analysis in 16 human solid tumour types","volume":"65","author":"Micke","year":"2021","journal-title":"EBioMedicine"},{"key":"10.1016\/j.sopen.2026.01.002_bb0060","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.3389\/fonc.2020.01472","article-title":"Pros and cons: high proportion of stromal component indicates better prognosis in patients with pancreatic ductal adenocarcinoma-a research based on the evaluation of whole-mount histological slides","volume":"10","author":"Li","year":"2020","journal-title":"Front Oncol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0065","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1038\/s41416-025-03019-z","article-title":"Tumor-stroma ratio combined with PD-L1 identifies pancreatic ductal adenocarcinoma patients at risk for lymph node metastases","volume":"132","author":"Chen","year":"2025","journal-title":"Br J Cancer"},{"key":"10.1016\/j.sopen.2026.01.002_bb0070","doi-asserted-by":"crossref","first-page":"4429","DOI":"10.1158\/1078-0432.CCR-17-0162","article-title":"Stratification of pancreatic ductal adenocarcinoma: combinatorial genetic, stromal, and immunologic markers","volume":"23","author":"Knudsen","year":"2017","journal-title":"Clin Cancer Res"},{"key":"10.1016\/j.sopen.2026.01.002_bb0075","doi-asserted-by":"crossref","first-page":"4183","DOI":"10.18632\/oncotarget.6770","article-title":"The prognostic role of desmoplastic stroma in pancreatic ductal adenocarcinoma","volume":"7","author":"Wang","year":"2016","journal-title":"Oncotarget"},{"key":"10.1016\/j.sopen.2026.01.002_bb0080","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.cgh.2008.05.006","article-title":"The activated stroma index is a novel and independent prognostic marker in pancreatic ductal adenocarcinoma","volume":"6","author":"Erkan","year":"2008","journal-title":"Clin Gastroenterol Hepatol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0085","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1002\/wjs.12269","article-title":"Prognostic factors based on histological categorization of desmoplastic reactions in pancreatic cancer","volume":"48","author":"Suzuki","year":"2024","journal-title":"World J Surg"},{"key":"10.1016\/j.sopen.2026.01.002_bb0090","doi-asserted-by":"crossref","first-page":"9415","DOI":"10.1038\/s41598-025-94362-x","article-title":"Stroma and lymphocytes identified by deep learning are independent predictors for survival in pancreatic cancer","volume":"15","author":"Tan","year":"2025","journal-title":"Sci Rep"},{"key":"10.1016\/j.sopen.2026.01.002_bb0095","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.ebiom.2019.04.008","article-title":"Quantitative proteomics identifies brain acid soluble protein 1 (BASP1) as a prognostic biomarker candidate in pancreatic cancer tissue","volume":"43","author":"Zhou","year":"2019","journal-title":"EBioMedicine"},{"key":"10.1016\/j.sopen.2026.01.002_bb0100","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"10.1016\/j.sopen.2026.01.002_bb0105","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1038\/sj.bjc.6602678","article-title":"REporting recommendations for tumour MARKer prognostic studies (REMARK)","volume":"93","author":"McShane","year":"2005","journal-title":"Br J Cancer"},{"key":"10.1016\/j.sopen.2026.01.002_bb0110","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1126\/science.1171362","article-title":"Inhibition of hedgehog signaling enhances delivery of chemotherapy in a mouse model of pancreatic cancer","volume":"324","author":"Olive","year":"2009","journal-title":"Science"},{"key":"10.1016\/j.sopen.2026.01.002_bb0115","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.ccr.2012.01.007","article-title":"Enzymatic targeting of the stroma ablates physical barriers to treatment of pancreatic ductal adenocarcinoma","volume":"21","author":"Provenzano","year":"2012","journal-title":"Cancer Cell"},{"key":"10.1016\/j.sopen.2026.01.002_bb0120","doi-asserted-by":"crossref","first-page":"4266","DOI":"10.1158\/1078-0432.CCR-11-3114","article-title":"The pancreas cancer microenvironment","volume":"18","author":"Feig","year":"2012","journal-title":"Clin Cancer Res"},{"key":"10.1016\/j.sopen.2026.01.002_bb0125","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.ccr.2014.04.005","article-title":"Depletion of carcinoma-associated fibroblasts and fibrosis induces immunosuppression and accelerates pancreas cancer with reduced survival","volume":"25","author":"\u00d6zdemir","year":"2014","journal-title":"Cancer Cell"},{"key":"10.1016\/j.sopen.2026.01.002_bb0130","article-title":"Stromal content is correlated with tissue site, contrast retention, and survival in pancreatic adenocarcinoma","volume":"2018","author":"Torphy","year":"2018","journal-title":"JCO Precis Oncol."},{"key":"10.1016\/j.sopen.2026.01.002_bb0135","article-title":"Innate and adaptive immune-directed tumour microenvironment in pancreatic ductal adenocarcinoma","volume":"15 - 2024","author":"Joseph","year":"2024","journal-title":"Front Immunol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0140","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1158\/2159-8290.CD-19-0094","article-title":"Cross-species single-cell analysis of pancreatic ductal adenocarcinoma reveals antigen-presenting cancer-associated fibroblasts","volume":"9","author":"Elyada","year":"2019","journal-title":"Cancer Discov"},{"key":"10.1016\/j.sopen.2026.01.002_bb0145","doi-asserted-by":"crossref","DOI":"10.1016\/j.tranon.2025.102282","article-title":"A practical distribution pattern of alpha-SMA-positive carcinoma associated fibroblasts indicates poor prognosis of patients with pancreatic ductal adenocarcinoma","volume":"52","author":"Li","year":"2025","journal-title":"Transl Oncol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0150","doi-asserted-by":"crossref","first-page":"19609","DOI":"10.1073\/pnas.1908626116","article-title":"Proteomic analyses of ECM during pancreatic ductal adenocarcinoma progression reveal different contributions by tumor and stromal cells","volume":"116","author":"Tian","year":"2019","journal-title":"Proc Natl Acad Sci U S A"},{"key":"10.1016\/j.sopen.2026.01.002_bb0155","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1038\/ng.3398","article-title":"Virtual microdissection identifies distinct tumor- and stroma-specific subtypes of pancreatic ductal adenocarcinoma","volume":"47","author":"Moffitt","year":"2015","journal-title":"Nat Genet"},{"key":"10.1016\/j.sopen.2026.01.002_bb0160","doi-asserted-by":"crossref","first-page":"5226","DOI":"10.1038\/s41467-023-40895-6","article-title":"Coordinated single-cell tumor microenvironment dynamics reinforce pancreatic cancer subtype","volume":"14","author":"Oh","year":"2023","journal-title":"Nat Commun"},{"key":"10.1016\/j.sopen.2026.01.002_bb0165","doi-asserted-by":"crossref","first-page":"3185","DOI":"10.1200\/JCO.20.00590","article-title":"Randomized phase III trial of pegvorhyaluronidase alfa with nab-paclitaxel plus gemcitabine for patients with Hyaluronan-high metastatic pancreatic adenocarcinoma","volume":"38","author":"Van Cutsem","year":"2020","journal-title":"J Clin Oncol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0170","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1038\/s41416-019-0683-3","article-title":"Phase 2 study of vismodegib, a hedgehog inhibitor, combined with gemcitabine and nab-paclitaxel in patients with untreated metastatic pancreatic adenocarcinoma","volume":"122","author":"De Jesus-Acosta","year":"2020","journal-title":"Br J Cancer"},{"key":"10.1016\/j.sopen.2026.01.002_bb0175","doi-asserted-by":"crossref","first-page":"4284","DOI":"10.1200\/JCO.2015.62.8719","article-title":"Randomized phase Ib\/II study of gemcitabine plus placebo or Vismodegib, a hedgehog pathway inhibitor, in patients with metastatic pancreatic cancer","volume":"33","author":"Catenacci","year":"2015","journal-title":"J Clin Oncol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0180","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.cell.2014.08.007","article-title":"Vitamin D receptor-mediated stromal reprogramming suppresses pancreatitis and enhances pancreatic cancer therapy","volume":"159","author":"Sherman","year":"2014","journal-title":"Cell"},{"key":"10.1016\/j.sopen.2026.01.002_bb0185","doi-asserted-by":"crossref","first-page":"2525","DOI":"10.1158\/0008-5472.CAN-15-1293","article-title":"TGF\u03b2 signaling in the pancreatic tumor microenvironment promotes fibrosis and immune evasion to facilitate tumorigenesis","volume":"76","author":"Principe","year":"2016","journal-title":"Cancer Res"},{"key":"10.1016\/j.sopen.2026.01.002_bb0190","doi-asserted-by":"crossref","DOI":"10.1126\/scitranslmed.ado2402","article-title":"Stromal reprogramming overcomes resistance to RAS-MAPK inhibition to improve pancreas cancer responses to cytotoxic and immune therapy","volume":"16","author":"Liu","year":"2024","journal-title":"Sci Transl Med"},{"key":"10.1016\/j.sopen.2026.01.002_bb0195","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.semcancer.2025.05.003","article-title":"The potential application of stroma modulation in targeting tumor cells: focus on pancreatic cancer and breast cancer models","volume":"113","author":"Roscigno","year":"2025","journal-title":"Semin Cancer Biol"},{"key":"10.1016\/j.sopen.2026.01.002_bb0200","first-page":"10","article-title":"Extent, impact, and mitigation of batch effects in tumor biomarker studies using tissue microarrays","author":"Stopsack","year":"2021","journal-title":"Elife"}],"container-title":["Surgery Open Science"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589845026000035?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2589845026000035?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T06:49:42Z","timestamp":1773989382000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2589845026000035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":40,"alternative-id":["S2589845026000035"],"URL":"https:\/\/doi.org\/10.1016\/j.sopen.2026.01.002","relation":{},"ISSN":["2589-8450"],"issn-type":[{"value":"2589-8450","type":"print"}],"subject":[],"published":{"date-parts":[[2026,3]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Digital quantification of stroma percentage enhances prognostic stratification in pancreatic cancer","name":"articletitle","label":"Article Title"},{"value":"Surgery Open Science","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.sopen.2026.01.002","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2026 The Authors. Published by Elsevier Inc.","name":"copyright","label":"Copyright"}]}}