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Clinical Cancer Research

Spatial Configuration of Residual Pancreatic Cancer Is Associated with Recurrence Risk

In 203 patients with pancreatic ductal adenocarcinoma who received neoadjuvant therapy and curative-intent resection and were restricted to minor pathologic response, an AI-enabled pipeline segmented cancer and stroma from routine H&E whole-slide images and quantified spatial composition and configuration, finding that a fragmented, interface-rich tumor-stroma ecology was independently associated with shorter disease-free survival; two spatial risk models (cancer mean shape index plus stromal shape index variability, adjusted HR 1.71, P = 0.003; mean stromal patch area plus edge density, adjusted HR 2.19, P = 0.