# Stratification of pancreatic ductal adenocarcinomas based on tumor and microenvironment features

Source: https://onco.cc/key-papers/paper-puleo-pancreatic-tumour-microenvironment-subtypes-gastroenterology-2018/  
OnCo record `paper-puleo-pancreatic-tumour-microenvironment-subtypes-gastroenterology-2018` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Using routine formalin-fixed tissue from 309 operations, this European study confirmed the classical and basal-like tumour types, added three microenvironment-defined groups, and showed the earlier exocrine-like type was contamination by normal acinar cells.

## Summary

Formalin-fixed paraffin-embedded samples from 309 consecutive resections at four European hospitals underwent gene expression, targeted sequencing and immunohistochemistry. Independent component analysis deconvoluted normal, tumour and microenvironment patterns; consensus clustering after removing normal contamination defined subtypes, associated with survival and validated in TCGA and ICGC. The basal-like and classical tumour-specific subtypes were validated and five subtypes were defined: pure basal-like, stroma activated, desmoplastic, pure classical and immune classical. An exocrine signal was associated with acinar cell contamination, and the previously reported exocrine-like (ADEX) subtype was attributed to it.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Journal: Gastroenterology
- Year: 2018
- DOI: 10.1053/j.gastro.2018.08.033
- Authors: Puleo F, Nicolle R, Blum Y, et al.
- Findings: Five subtypes: pure basal-like, stroma activated, desmoplastic, pure classical, immune classical.; ADEX and exocrine-like reflect acinar contamination.
- What it means: It made subtyping possible on the archived tissue every hospital has, and it retired one of the four Bailey subtypes.
- Caveats: Resected tumours only.; Subtypes are prognostic, not yet predictive.

## Sources

- Puleo et al., Gastroenterology 2018: five tumour and microenvironment subtypes in 309 resected cancers: https://doi.org/10.1053/j.gastro.2018.08.033
- PubMed: https://pubmed.ncbi.nlm.nih.gov/30165049/

## Connected records

- cancers: [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/)
- technologies: [RNA sequencing & expression profiling](https://onco.cc/technologies/rna-seq/)
- institutions: [Institut Jules Bordet](https://onco.cc/institutions/institut-jules-bordet/)
- pathways: [Fibroblast activation, desmoplasia & matrix stiffness](https://onco.cc/pathways/caf-activation-desmoplasia/), [Tumour microenvironment (TME)](https://onco.cc/pathways/tumor-microenvironment/)
- journals: [Gastroenterology](https://onco.cc/journals/gastroenterology/)

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