Direct Tumor-Adipocyte Contact as a Prognostic Biomarker in Resected Pancreatic Ductal Adenocarcinoma
- Journal
- European journal of cancer (Oxford, England : 1990) (Q1)
- Published
- 10 September 2026
- Study design
- Unclassified
- Evidence level
- Level 5, Expert Opinion (CEBM 5)
- Authors
- Michael Günther, Konstantin Bräutigam, Martin Wartenberg, Muhammed D Arslan, Robert Sucher, Mohamed El-Mahrouk, et al.
- PMID
- 42777382
- DOI
- 10.1016/j.ejca.2026.117035
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 25 September 2026): TAC/SARIFA prognostic biomarker in resected PDAC
Abstract
BACKGROUND: Direct tumor-adipocyte contact (TAC), also referred to as Stroma AReactive Invasion Front Areas (SARIFA), is an emerging histomorphologic biomarker, defined by histologically visible direct tumor-adipocyte interaction. Its prognostic relevance in pancreatic ductal adenocarcinoma (PDAC) has not been investigated across independent cohorts. METHODS: In this international, real-world, multicenter study, TAC/SARIFA was assessed on 941 resected PDAC cases across five cohorts (Munich n = 400, Bern n = 215, Graz n = 111, Erlangen n = 101, TCGA n = 114). Clinicopathological correlations, survival analyses, and differential gene expression analyses were performed. RESULTS: TAC/SARIFA positivity was present in 53% of evaluable cases and showed substantial interobserver agreement across seven pathologists (mean Cohen's kappa: 0.71). TAC/SARIFA-positive tumors were associated with higher nodal (pN) stage, higher tumor grade, and older patient age (each p < 0.01). TAC/SARIFA positivity was significantly associated with reduced overall survival (pooled median OS: 14.1 vs. 28.0 months, p < 0.001) and remained an independent prognostic factor in multivariate analysis (pooled HR 1.84, 95% CI 1.59-2.14, p < 0.001). A significant interaction between TAC/SARIFA and sex was identified (p < 0.001), with a stronger prognostic effect in males (HR 2.46) than in females (HR 1.50). Adjuvant chemotherapy was associated with longer OS in both TAC/SARIFA subgroups, with a greater absolute survival difference in TAC/SARIFA-positive patients. Bulk transcriptomic profiling revealed upregulation of leptin (LEP) and the basal-like marker KRT14 in TAC/SARIFA-positive tumors. CONCLUSIONS: TAC/SARIFA is a robust, independent prognostic histomorphologic biomarker in PDAC with a sex-dependent effect. Its reproducible and quick assessment on routine H&E slides supports further investigation of its applicability for PDAC risk stratification.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.