Stromal Podoplanin Expression as a Prognostic Biomarker in Pancreatic Ductal Adenocarcinoma

INTRODUCTION: Pancreatic cancer is known for its poor prognosis, characterized by early systemic dissemination and locally aggressive behavior. Podoplanin (PDPN) is a mucin-type transmembrane glycoprotein physiologically expressed in various tissues. In certain malignancies, overexpression of PDPN has been linked to enhanced tumor invasiveness, metastatic potential, and unfavorable clinical outcomes. In this study, we evaluated stromal PDPN expression in a cohort of patients diagnosed with pancreatic carcinoma and investigated its immunohistochemical profile in relation to patient survival. METHODS: This retrospective study included 103 cases of pancreatic ductal adenocarcinoma (PDAC). Histologic grade, perineural invasion, pathological tumor stage, lymph node status, and lymphovascular invasion were evaluated. Immunohistochemical expression of podoplanin was evaluated as a percentage by calculating the proportion of PDPN-positive (of any staining intensity) tumor stroma relative to the total tumor stromal area. RESULTS: Among 103 cases of PDAC, the median value of immunohistochemical expression of podoplanin in tumor stroma was 20%. Complete absence of PDPN expression was observed in 7 patients (6.8%). The survival analysis indicated that higher stromal podoplanin expression was associated with shorter overall survival (log-rank p = 0.0129). High PDPN expression in cancer-associated fibroblasts (CAFs) showed a borderline association with overall survival in multivariable Cox regression analysis (HR: 1.52, 95% CI: 1.00-2.32, p = 0.05). CONCLUSION: PDPN expression may serve as a prognostic biomarker in PDAC and could contribute to future therapeutic stratification.