评估胰腺导管腺癌 (PDAC) 的形态学景观、肿瘤内空间异质性以及新辅助胰腺切除术后产生的临床影响。PDAC 形态亚型和治疗后肿瘤内空间异质性的临床价值仍然是一个悬而未决的问题。包括 2013 年至 2019 年间在维罗纳大学医院信托基金接受 PDAC 新辅助胰腺切除术后的患者。对所有苏木精和伊红染色的切片进行审查，以评估 PDAC 组织形态学和肿瘤内异质性。使用标准统计数据评估与其他临床病理学变量、总生存期 (OS) 和无复发生存期 (RFS) 的关系。研究队列包括 400 名患者。组织学修正确定了十种不同的形态学亚型。具有传统模式的腺体形成 PDAC 是最常见的亚型 (41.8%)。总体而言，247 个肿瘤 (61.7%) 仅显示一种组织学模式，被归类为同质肿瘤，而 153 个肿瘤 (38.3%) 显示不同的形态，被归类为异质肿瘤。切除后中位生存期为 30.1 个月 (95% CI 26.6-33.5)。根据形态亚型的不同，生存期存在显着差异，从回旋亚型的 19.1 个月到乳头状亚型的 47.0 个月不等。相对于空间同质肿瘤，具有异质形态的肿瘤表现出更高的淋巴结转移率、更差的肿瘤消退指标和更差的肿瘤学结果。本文提供了 PDAC 新辅助胰腺切除术后残留肿瘤的形态学分类。形态亚型和肿瘤内空间异质性具有相关的预后意义，可以包含在病理报告中以补充回归指标。版权所有 © 2024 Wolters Kluwer Health, Inc. 保留所有权利。

To evaluate the morphologic landscape of pancreatic ductal adenocarcinoma (PDAC), intratumor spatial heterogeneity, and the resulting clinical impact following post-neoadjuvant pancreatectomy.The clinical value of PDAC morphologic subtypes and intratumor spatial heterogeneity post-treatment remains an open issue.The study cohort included patients who underwent post-neoadjuvant pancreatectomy for PDAC at the University of Verona Hospital Trust between 2013 and 2019. All hematoxylin and eosin-stained slides were reviewed to assess PDAC histomorphology and intratumor heterogeneity. The relationship with other clinicopathological variables, overall survival (OS), and recurrence-free (RFS) survival was evaluated using standard statistics.The study cohort included 400 patients. Histological revision identified ten different morphologic subtypes. Gland-forming PDAC with a conventional pattern was the most frequently identified subtype (41.8%). Overall, 247 tumors (61.7%) showed only one histological pattern and were classified as homogeneous, whereas 153 (38.3%) showed different morphologies and were classified as heterogeneous tumors. The median post-resection survival was 30.1 months (95%CI 26.6-33.5). There was a substantial survival variability according to the morphologic subtype, ranging from 19.1 months in the gyriform subtype to 47.0 months in the papillary subtype. Tumors with a heterogeneous morphology displayed a higher rate of nodal metastases, worse tumor regression metrics, and worse oncologic outcomes relative to spatially homogeneous tumors.This paper provided a morphological taxonomy of residual tumors following post-neoadjuvant pancreatectomy for PDAC. The morphologic subtype and intratumor spatial heterogeneity have relevant prognostic implications and could be included in the pathology report to complement regression metrics.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.