Development of a nomogram integrating immune checkpoints, fibrosis indicators, and clinicopathological characteristics to predict overall survival in pancreatic cancer: a retrospective analysis

High PD-L1 expression is associated with enhanced fibrosis, greater tumor burden, and nodal metastasis in PC. Patients exhibiting elevated PD-L1 levels, significant fibrotic burden, advanced T or N stage, or increased NLR demonstrate reduced OS. The developed nomogram enhances individualized prediction of OS. These findings support the hypothesis that combining immune checkpoint blockade, TGF-β inhibition, and chemotherapy may represent a promising therapeutic strategy for PC patients with high PD-L1 expression and pronounced fibrosis.