{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T21:58:17Z","timestamp":1786658297693,"version":"build-2736575974"},"reference-count":54,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T00:00:00Z","timestamp":1741219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy of Timisoara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Pancreatic ductal adenocarcinoma is an aggressive neoplasm with a complex carcinogenesis process that must be understood through the interactions between tumor cells and tumor microenvironment cells. Methods: This study was retrospective with a chronological extension period of 16 years and included 56 cases of pancreatic ductal adenocarcinoma. This study identified, quantified, and correlated the cells of the tumor immune microenvironment in pancreatic ductal adenocarcinoma with major prognostic factors as well as overall survival, using an extensive panel of immunohistochemical markers. Results: Three tumor immunotypes were identified: subtype A (hot immunotype), subtype B (intermediate immunotype), and subtype C (cold immunotype). Patients with immunotype C exhibit considerably higher rates of both pancreatic fistulas and acute pancreatitis. Immunotypes B and C significantly increased the risk of this complication by factors of 3.68 (p = 0.002) and 3.94 (p = 0.001), respectively. The estimated probabilities of fistula formation for each immunotype are as follows: 2.5% for immunotype A, 25% for immunotype B, and 28% for immunotype C. There was a statistically significant difference in median survival times according to tumor immunotype (p &lt; 0.001). Specifically, patients with immunotype C tumors had a median survival time of only 120.5 days, compared to 553.5 days for those with immunotype A and 331.5 for immunotype B tumors. Conclusions: The identification of the immunotype of pancreatic ductal adenocarcinoma can be a predictive factor for the occurrence of complications such as pancreatic fistula as well as for overall survival.<\/jats:p>","DOI":"10.3390\/diagnostics15050646","type":"journal-article","created":{"date-parts":[[2025,3,6]],"date-time":"2025-03-06T09:59:17Z","timestamp":1741255157000},"page":"646","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Immunohistochemical Evaluation of the Tumor Immune Microenvironment in Pancreatic Ductal Adenocarcinoma"],"prefix":"10.3390","volume":"15","author":[{"given":"Gelu Mihai","family":"Breaza","sequence":"first","affiliation":[{"name":"Department of Microscopic Morphology, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"},{"name":"University Clinic of Surgery I, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1397-1864","authenticated-orcid":false,"given":"Raluca Maria","family":"Closca","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"},{"name":"Department of Pathology, Emergency City Hospital, 300254 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7935-4471","authenticated-orcid":false,"given":"Alexandru Cristian","family":"Cindrea","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"},{"name":"Emergency Department, Emergency Clinical Municipal Hospital, 300079 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florin Emil","family":"Hut","sequence":"additional","affiliation":[{"name":"University Clinic of Surgery I, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"},{"name":"Center for Hepato-Bilio-Pancreatic Surgery, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Octavian","family":"Cretu","sequence":"additional","affiliation":[{"name":"University Clinic of Surgery I, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2854-7449","authenticated-orcid":false,"given":"Laurentiu Vasile","family":"Sima","sequence":"additional","affiliation":[{"name":"University Clinic of Surgery I, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Rakitovan","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"},{"name":"Oro-Maxillo-Facial Surgery Clinic, Emergency City Hospital, 300062 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5755-179X","authenticated-orcid":false,"given":"Flavia","family":"Zara","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology, University of Medicine and Pharmacy \u201cVictor Babes\u201d, 300041 Timisoara, Romania"},{"name":"Department of Pathology, Emergency City Hospital, 300254 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1016\/j.cell.2023.02.014","article-title":"Pancreatic cancer: Advances and challenges","volume":"186","author":"Halbrook","year":"2023","journal-title":"Cell"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4298","DOI":"10.3748\/wjg.v27.i27.4298","article-title":"Pancreatic cancer: A review of epidemiology, trend, and risk factors","volume":"27","author":"Hu","year":"2021","journal-title":"World J. 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