Objectives: To investigate the immune micro-environment in tumors of patients with pancreatic ductal adenocarcinoma (PDAC) after immediate surgery or neoadjuvant therapy and its relation to survival outcome. Methods: We analysed tumor samples from 50 patients without and 53 patients with neoadjuvant chemo-radiotherapy. Immune profiling of FFPE tumor samples was performed using the NanoString PanCancer assay and the expression of 770 immune related genes was measured. We used the two sample T-test for comparison of gene expression levels between the two groups. The multivariate Cox proportional hazards model was performed to identify independent prognostic predictors. The Kaplan-Meier method with a log-rank test was applied to compare the survival distributions between groups. Results: Total tumor infiltrating lymphocytes (TILs) was equally distributed between treatment groups. B cell infiltration was decreased significantly (p< 0,001) in the neoadjuvant group, whereas T cell infiltration did not vary between groups. Furthermore, CXCL12 expression, a chemokine involved in tumor proliferation and progression, was significantly (p< 0,0001) higher in neoadjuvant treated tumors. However, its receptor CXCR4 was down regulated. In addition, high expression of the ALCAM gene was strongly associated with poor prognosis in both treatment
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