Neuro-related tertiary lymphoid structures predict chemotherapy sensitivity in pancreatic cancer

Spatial transcriptomic analysis was conducted using the NanoString GeoMx Digital Spatial Profiler Human Whole Transcriptome Atlas on tissue sections from 6 patients including 3 from neoadjuvant chemotherapy (NAT) group and 3 from the surgery alone (SA) group. Notably, all samples from the NAT group were derived from patients who had only received neoadjuvant albumin-bound paclitaxel and gemcitabine regimen. Consecutive sections were stained with fluorophore-conjugated antibodies for structural segmentation: PanCK was used to demarcate ductal carcinoma cells, while S100β labeled the nerve region. ROIs were manually annotated around morphologically intact nerves, deliberately excluding regions where tumor involvement was present. 3-4 ROIs were selected for each patient. A total of 14 ROIs were selected, 7 from the NAT group and 7 from the SA group.