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Pancreatic Neoplasms: HELP
Articles by Birte Kulemann
Based on 10 articles published since 2010
(Why 10 articles?)
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Between 2010 and 2020, B. Kulemann wrote the following 10 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Review [Circulating tumor cells in pancreatic cancer : Results of morphological and molecular analyses and comparisons with the primary tumor]. 2018

Timme-Bronsert, S / Bronsert, P / Werner, M / Kulemann, B / Höppner, J. ·Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Breisacher Straße 115A, 79106, Freiburg, Deutschland. sylvia.timme@uniklinik-freiburg.de. · Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland. sylvia.timme@uniklinik-freiburg.de. · Institut für Klinische Pathologie, Universitätsklinikum Freiburg, Breisacher Straße 115A, 79106, Freiburg, Deutschland. · Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland. · Biobank Tumorzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland. · Department für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland. ·Pathologe · Pubmed #30483865.

ABSTRACT: BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a disease with a poor prognosis. PDAC shows characteristic mutations within codon 12/13. Circulating tumor cells (CTC) detected in blood samples of patients with cancer are hypothesized as the means of systemic tumor spread. But less is known about morphological/molecular characteristics or the pathophysiological meaning of PDAC CTC. OBJECTIVES: The aim of the study was a cytomorphological and genetic analysis of CTC from patients with PDAC followed by the correlation of the results with those of the corresponding tumor in the pancreas. MATERIAL AND METHODS: Blood samples of 58 patients with PDAC and 10 "normal" control donors were processed through a size-based CTC isolation. KRAS-mutation analyses were performed for CTC and the primary tumor and the results were compared. Furthermore, their potential as a prognostic marker was evaluated. RESULTS: In patients with different UICC stages CTC were detected, but not in normal control patients. There was a trend for a worse median overall survival (OS) for patients with >3 CTC/ml. Patients with a KRAS CONCLUSIONS: Detection and characterization of CTC (for example by KRAS mutation analysis) may be useful for prognosis. Furthermore, it expands our knowledge of tumor biology and may detect possible tumor heterogeneity regarding the mutation profile of some cancer types.

2 Review Sonic Hedgehog in pancreatic cancer: from bench to bedside, then back to the bench. 2012

Rosow, David E / Liss, Andrew S / Strobel, Oliver / Fritz, Stefan / Bausch, Dirk / Valsangkar, Nakul P / Alsina, Janivette / Kulemann, Birte / Park, Joo Kyung / Yamaguchi, Junpei / LaFemina, Jennifer / Thayer, Sarah P. ·Pancreatic Biology Laboratory, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA. ·Surgery · Pubmed #22770959.

ABSTRACT: -- No abstract --

3 Clinical Trial Circulating tumor cells found in patients with localized and advanced pancreatic cancer. 2015

Kulemann, Birte / Pitman, Martha B / Liss, Andrew S / Valsangkar, Nakul / Fernández-Del Castillo, Carlos / Lillemoe, Keith D / Hoeppner, Jens / Mino-Kenudson, Mari / Warshaw, Andrew L / Thayer, Sarah P. ·From the *Department of Surgery and †Andrew L. Warshaw Institute for Pancreatic Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA; ‡Department of Surgery, University Hospital Freiburg, Freiburg, Germany; §Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA; and ║Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE. ·Pancreas · Pubmed #25822154.

ABSTRACT: OBJECTIVES: Isolation of circulating tumor cells (CTCs) holds the promise of diagnosing and molecular profiling cancers from a blood sample. Here, we test a simple new low-cost filtration device for CTC isolation in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: Peripheral blood samples drawn from healthy donors and PDAC patients were filtered using ScreenCell devices, designed to capture CTCs for cytologic and molecular analysis. Giemsa-stained specimens were evaluated by a pancreatic cytopathologist blinded to the histological diagnosis. Circulating tumor cell DNA was subjected to KRAS mutational analysis. RESULTS: Spiking experiments demonstrated a CTC capture efficiency as low as 2 cells/mL of blood. Circulating tumor cells were identified by either malignant cytology or presence of KRAS mutation in 73% of 11 patients (P = 0.001). Circulating tumor cells were identified in 3 of 4 patients with early (≤American Joint Committee on Cancer stage IIB) and in 5 of 7 patients with advanced (≥ American Joint Committee on Cancer stage III) PDAC. No CTCs were detected in blood from 9 health donors. CONCLUSIONS: Circulating tumor cells can be found in most patients with PDAC of any stage, whether localized, locally advanced, or metastatic. The ability to capture, cytologically identify, and genetically analyze CTCs suggests a possible tool for the diagnosis and characterization of genetic alterations of PDAC.

4 Article ADAM9 contributes to vascular invasion in pancreatic ductal adenocarcinoma. 2019

Oria, Victor O / Lopatta, Paul / Schmitz, Tatjana / Preca, Bogdan-Tiberius / Nyström, Alexander / Conrad, Catharina / Bartsch, Jörg W / Kulemann, Birte / Hoeppner, Jens / Maurer, Jochen / Bronsert, Peter / Schilling, Oliver. ·Institute of Molecular Medicine and Cell Research, University of Freiburg, Germany. · Spemann Graduate School of Biology and Medicine, University of Freiburg, Germany. · Faculty of Biology, University of Freiburg, Germany. · Department of Biomedicine, University of Basel, Switzerland. · Department of Dermatology, Medical Faculty, Medical Center - University of Freiburg, Germany. · Department of Neurosurgery, Philipps University Marburg, Germany. · Department of Anesthesiology, Intensive Care, and Pain Medicine, University of Münster, Germany. · Department of General and Visceral Surgery, Medical Center - University of Freiburg, Germany. · Faculty of Medicine, University of Freiburg, Germany. · Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Germany. · Department of Gynecology, University Clinic RWTH, Aachen, Germany. · Institute of Surgical Pathology, Medical Center - University of Freiburg, Germany. · German Cancer Consortium (DKTK) and Cancer Research Center (DKFZ), Heidelberg, Germany. · Tumorbank Comprehensive Cancer Center Freiburg, Medical Center - University of Freiburg, Germany. · Centre for Biological Signaling Studies BIOSS, University of Freiburg, Germany. ·Mol Oncol · Pubmed #30556643.

ABSTRACT: A disintegrin and a metalloprotease (ADAM)-9 is a metzincin cell-surface protease with strongly elevated expression in solid tumors, including pancreatic ductal adenocarcinoma (PDAC). In this study, we performed immunohistochemistry (IHC) of a tissue microarray (TMA) to examine the expression of ADAM9 in a cohort of >100 clinically annotated PDAC cases. We report that ADAM9 is prominently expressed by PDAC tumor cells, and increased ADAM9 expression levels correlate with poor tumor grading (P = 0.027) and the presence of vasculature invasion (P = 0.017). We employed gene expression silencing to generate a loss-of-function system for ADAM9 in two established PDAC cell lines. In vitro analysis showed that loss of ADAM9 does not impede cellular proliferation and invasiveness in basement membrane. However, ADAM9 plays a crucial role in mediating cell migration and adhesion to extracellular matrix substrates such as fibronectin, tenascin, and vitronectin. This effect appears to depend on its catalytic activity. In addition, ADAM9 facilitates anchorage-independent growth. In AsPC1 cells, but not in MiaPaCa-2 cells, we noted a pronounced yet heterogeneous impact of ADAM9 on the abundance of various integrins, a process that we characterized as post-translational regulation. Sprout formation of human umbilical vein endothelial cells (HUVECs) is promoted by ADAM9, as examined by transfer of cancer cell conditioned medium; this finding further supports a pro-angiogenic role of ADAM9 expressed by PDAC cancer cells. Immunoblotting analysis of cancer cell conditioned medium highlighted that ADAM9 regulates the levels of angiogenic factors, including shed heparin-binding EGF-like growth factor (HB-EGF). Finally, we carried out orthotopic seeding of either wild-type AsPC-1 cells or AsPC-1 cells with silenced ADAM9 expression into murine pancreas. In this in vivo setting, ADAM9 was also found to foster angiogenesis without an impact on tumor cell proliferation. In summary, our results characterize ADAM9 as an important regulator in PDAC tumor biology with a strong pro-angiogenic impact.

5 Article Cytologic characteristics of circulating epithelioid cells in pancreatic disease. 2017

Rosenbaum, Matthew W / Cauley, Christy E / Kulemann, Birte / Liss, Andrew S / Castillo, Carlos Fernandez-Del / Warshaw, Andrew L / Lillemoe, Keith D / Thayer, Sarah P / Pitman, Martha B. ·Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts. · Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. · Department of Surgery, University Hospital Freiburg, Freiburg, Germany. · Division of Surgical Oncology, Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska. ·Cancer Cytopathol · Pubmed #28257167.

ABSTRACT: BACKGROUND: Circulating epithelioid cells (CECs), also known as circulating tumor, circulating cancer, circulating epithelial, or circulating nonhematologic cells, are a prognostic factor in various malignancies that can be isolated via various protocols. In the current study, the authors analyzed the cytomorphologic characteristics of CECs isolated by size in a cohort of patients with benign and malignant pancreatic diseases to determine whether cytomorphological features could predict CEC origin. METHODS: Blood samples were collected from 9 healthy controls and 171 patients with pancreatic disease who were presenting for surgical evaluation before treatment. Blood was processed with the ScreenCell size-based filtration device. Evaluable CECs were analyzed in a blinded fashion for cytomorphologic characteristics, including cellularity; nucleoli; nuclear size, irregularity, variability, and hyperchromasia; and nuclear-to-cytoplasmic ratio. Statistical differences between variables were analyzed via the Fisher exact test. RESULTS: No CECs were identified among the 9 normal healthy controls. Of the 115 patients with CECs (positive or suspicious for), 25 had nonmalignant disease and 90 had malignancy. There were no significant differences in any of the cytologic criteria noted between groups divided by benign versus malignant, neoplastic versus nonneoplastic, or pancreatic ductal adenocarcinoma versus neuroendocrine tumor. CONCLUSIONS: CECs were observed in patients with malignant and nonmalignant pancreatic disease, but not in healthy controls. There were no morphologic differences observed between cells from different pancreatic diseases, suggesting that numerous conditions may be associated with CECs in the circulation and that care must be taken not to overinterpret cells identified by cytomorphology as indicative of circulating tumor cells of pancreatic cancer. Additional studies are required to determine the origin and clinical significance of these cells. Cancer Cytopathol 2017;125:332-340. © 2017 American Cancer Society.

6 Article Prognostic Role of Log Odds of Lymph Nodes After Resection of Pancreatic Head Cancer. 2016

Riediger, Hartwig / Kulemann, Birte / Wittel, Uwe / Adam, Ulrich / Sick, Olivia / Neeff, Hannes / Höppner, Jens / Hopt, Ulrich T / Makowiec, Frank. ·Department of Surgery, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany. · Department of Surgery, Vivantes-Humboldt-Klinikum, Berlin, Germany. · Department of Surgery, University of Freiburg, Hugstetterstrasse 55, D-79106, Freiburg, Germany. frank.makowiec@uniklinik-freiburg.de. ·J Gastrointest Surg · Pubmed #27384432.

ABSTRACT: INTRODUCTION: Nodal status is a strong prognostic factor after resection of pancreatic cancer. The lymph node ratio (LNR) has been shown to be superior to the pN status in several studies. The role of log odds of the ratio between positive and negative nodes (LODDS) as a suggested new indicator of prognosis, however, has been hardly evaluated in pancreatic cancer. METHODS: Prognostic factors for overall survival after resection for cancer of the pancreatic head were evaluated in 409 patients from two institutions (prospectively maintained databases). The lymph node status, LNR, and LODDS were separately analyzed and independently compared in multivariate survival analysis. RESULTS: The median numbers of examined and positive lymph nodes were 16 and 2, respectively. Actuarial 3- and 5-year survival rates were 29 and 16 %. All three classifications of nodal disease significantly predicted survival in the entire group (n = 409), in patients with free resection margins (n = 297), and in patients with <12 examined nodes. In multivariate analysis, however, both LNR and LODDS were equally superior to the nodal status. In node-negative patients (n = 110), LODDS could not identify subgroups with different prognosis. CONCLUSION: Both LNR and LODDS are superior to the classical nodal status in predicting prognosis in resected pancreatic cancer. However, LODDS has not shown any advantage over LNR in our series, neither in the entire patient group nor in the subgroups with free margins, negative nodes or a low number of examined nodes. Therefore, the use of LODDS to predict the outcome after resection of pancreatic head cancer cannot be recommended.

7 Article Mesopancreatic Stromal Clearance Defines Curative Resection of Pancreatic Head Cancer and Can Be Predicted Preoperatively by Radiologic Parameters: A Retrospective Study. 2016

Wellner, Ulrich F / Krauss, Tobias / Csanadi, Agnes / Lapshyn, Hryhoriy / Bolm, Louisa / Timme, Sylvia / Kulemann, Birte / Hoeppner, Jens / Kuesters, Simon / Seifert, Gabriel / Bausch, Dirk / Schilling, Oliver / Vashist, Yogesh K / Bruckner, Thomas / Langer, Mathias / Makowiec, Frank / Hopt, Ulrich T / Werner, Martin / Keck, Tobias / Bronsert, Peter. ·From the Clinic for Surgery, UKSH Campus Lübeck, Lübeck (UFW, HL, LB, DB, TK) · Clinic for Radiology (TK, ML) · Institute of Pathology (AC, ST, MW, PB) · Clinic for General and Visceral Surgery, University Medical Center Freiburg (BK, JH, SK, GS, FM, UTH) · Institute for Molecular Medicine and Cell Research, University of Freiburg, Freiburg (OS) · Department of Surgery, University Hospital Hamburg-Eppendorf (UKE), Hamburg (YKV) · Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Heidelberg (TB) · Comprehensive Cancer Center Freiburg, Freiburg (ML, FM, UTH, MW, PB) · and German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany (OS, MW, PB). ·Medicine (Baltimore) · Pubmed #26817896.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is characterized by a strong fibrotic stromal reaction and diffuse growth pattern. Peritumoral fibrosis is often evident during surgery but only distinguishable from tumor by microscopic examination. The aim of this study was to investigate the role of clearance of fibrotic stromal reaction at the mesopancreatic resection margin as a criterion for radical resection and preoperative assessment of resectability.Mesopancreatic stromal clearance status (S-status) was defined as the presence or absence (S+/S0) of fibrotic stromal reaction at the mesopancreatic resection margin. Detailed retrospective clinicopathologic re-evaluation of margin status and preoperative cross-sectional imaging was performed in a cohort of 91 patients operated for pancreatic head PDAC from 2001 to 2011.Conventional margin positive resection (R+, tumor cells directly at the margin) was found in 36%. However, S-status further divided the margin negative (R0) group into patients with median survival of 14 months versus 31 months (S+ versus S0, P = 0.005). Overall rate of S+ was 53%. S-status and lymph node ratio constituted the only independent predictors of survival. Stranding of the superior mesenteric artery fat sheath was the only independent radiologic predictor of S+ resection, and achieved a 71% correct prediction of S-status.Mesopancreatic stromal clearance is a major determinant of curative resection in PDAC, and preoperative prediction by cross-sectional imaging is possible, setting the basis for a new definition of borderline resectability.

8 Article KRAS mutations in pancreatic circulating tumor cells: a pilot study. 2016

Kulemann, Birte / Liss, Andrew S / Warshaw, Andrew L / Seifert, Sindy / Bronsert, Peter / Glatz, Torben / Pitman, Martha B / Hoeppner, Jens. ·Department of Surgery, University of Freiburg Medical Center, Hugstetter Str. 55, D-79106, Freiburg, Germany. birte.kulemann@uniklinik-freiburg.de. · Department of Surgery & Andrew L. Warshaw, MD Institute for Pancreatic Cancer Research, Massachusetts General Hospital/ Harvard Medical School, Boston, MA, USA. · Department of Surgery, University of Freiburg Medical Center, Hugstetter Str. 55, D-79106, Freiburg, Germany. · Department of Pathology, University of Freiburg Medical Center, Freiburg, Germany. · Comprehensive Cancer Center, University of Freiburg Medical Center, Freiburg, Germany. · Department of Pathology, Massachusetts General Hospital, Boston, MA, USA. ·Tumour Biol · Pubmed #26684803.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is most often diagnosed in a metastatic stage. Circulating tumor cells (CTC) in the blood are hypothesized as the means of systemic dissemination. We aimed to isolate and characterize CTC to evaluate their significance as prognostic markers in PDAC. Blood obtained from healthy donors and patients with PDAC before therapy was filtered with ScreenCell® filtration devices for size-based CTC isolation. Captured cells were analyzed by immunofluorescence for an epithelial to mesenchymal transition (EMT) marker (zinc finger E-box binding homebox 1 (ZEB1)) and an epithelial antigen (cytokeratin (CK)). Molecular analysis of parallel specimens evaluated the KRAS mutation status of the CTC. The survival of each patient after study was recorded. As demonstrated by either cytology or finding of a KRAS mutation, CTC were detected in 18 of 21 patients (86 %) with proven PDAC: 8 out of 10 patients (80 %) with early stage (UICC IIA/IIB) and 10 out of 11 (91 %) with late stage (UICC III/IV) disease. CTC were not found in any of the 10 control patients (p < 0.001). The presence of CTC did not adversely affect median survival: 16 months in CTC-positive (n = 18) vs. 10 months in CTC-negative (n = 3) patients. Neither ZEB1 nor cytological characteristics correlated with overall survival, although ZEB1 was found almost exclusively in CTC of patients with established metastases. Patients with a CTC KRAS mutation (CTC-KRAS (mut)) had a substantially better survival, 19.4 vs. 7.4 months than patients with wild type KRAS (p = 0.015). With ScreenCell filtration, CTC are commonly found in PDAC (86 %). Molecular and genetic characterization, including mutations such as KRAS, may prove useful for prognosis.

9 Article Perioperative and long-term outcome after standard pancreaticoduodenectomy, additional portal vein and multivisceral resection for pancreatic head cancer. 2015

Kulemann, Birte / Hoeppner, Jens / Wittel, Uwe / Glatz, Torben / Keck, Tobias / Wellner, Ulrich F / Bronsert, Peter / Sick, Olivia / Hopt, Ulrich T / Makowiec, Frank / Riediger, Hartwig. ·Department of Surgery, University of Freiburg, Hugstetter Str. 55, D-79106, Freiburg, Germany, birte.kulemann@gmail.com. ·J Gastrointest Surg · Pubmed #25567663.

ABSTRACT: INTRODUCTION: The value of extended resection (portal vein, multivisceral) in patients with pancreatic adenocarcinoma (PDAC) is not well defined. We analyzed the outcome after standard resection (standard pancreaticoduodenectomy (SPR)), additional portal vein (PV) and multivisceral (MV) resection in PDAC patients. METHODS: Clinicopathologic, perioperative, and survival data of patients undergoing pancreatic head resection (PHR) for PDAC 1994-2014 were reviewed from a prospective database. RESULTS: Three hundred fifty nine patients had PHR for PDAC: 208 (58 %) underwent SPR, 131 (36 %) additional PV, and 20 (6 %) MV. The postoperative complication rate in MV (65 %) was slightly higher than in PV (56 %) or SPR (50 %; p = 0.32). MV patients had higher in-hospital mortality (10 %) than SPR (3.8 %) and PV (1.5 %) patients (p = 0.12). Nodal status was comparable, whereas more patients in PV and MV had final R0 resection (p = 0.02). Five-year survival was 7 % after MV versus 17 % in patients without MV (p = 0.07). Multivariate survival analysis identified resection margin, nodal disease, blood transfusions, and MV are set as independent risk factors for overall survival. CONCLUSION: Multivisceral pancreatic head resections for PDAC are associated with increased perioperative morbidity and mortality, without improving oncologic outcome. Portal vein resection can be performed safely to reach R0 resection and its survival benefits.

10 Article Prognostic significance of Zinc finger E-box binding homeobox 1 (ZEB1) expression in cancer cells and cancer-associated fibroblasts in pancreatic head cancer. 2014

Bronsert, Peter / Kohler, Ilona / Timme, Sylvia / Kiefer, Selina / Werner, Martin / Schilling, Oliver / Vashist, Yogesh / Makowiec, Frank / Brabletz, Thomas / Hopt, Ulrich T / Bausch, Dirk / Kulemann, Birte / Keck, Tobias / Wellner, Ulrich F. ·Institute of Pathology, University Medical Center Freiburg, Freiburg, Germany; Comprehensive Cancer Center, Freiburg, Germany. Electronic address: peter.bronsert@uniklinik-freiburg.de. · Institute of Pathology, University Medical Center Freiburg, Freiburg, Germany. · Institute of Pathology, University Medical Center Freiburg, Freiburg, Germany; Comprehensive Cancer Center, Freiburg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany. · Institute for Molecular Medicine and Cell Research, University of Freiburg, Freiburg, Germany. · Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany. · Comprehensive Cancer Center, Freiburg, Germany; Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany. · German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany; Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany. · Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany. · Clinic for General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany; Clinic for Surgery, University Clinic Schleswig-Holstein Campus, Lübeck, Germany. ·Surgery · Pubmed #24929761.

ABSTRACT: BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is characterized by an aggressive biology and poor prognosis. Experimental evidence has suggested a role for the transcriptional repressor Zinc finger E-box binding homeobox 1 (ZEB1) in epithelial-mesenchymal transition, invasion, and metastasis in PDAC. ZEB1 expression has been observed in cancer cells as well as stromal fibroblasts. Our study aimed to evaluate the prognostic value of ZEB1 expression in PDAC tissue. METHODS: Patient baseline and follow-up data were extracted from a prospectively maintained database. After clinicopathologic re-review, serial sliced tissue slides were immunostained for ZEB1, E-cadherin, vimentin, and pan-cytokeratin. ZEB1 expression in cancer cells and adjacent stromal fibroblasts was graded separately and correlated to routine histopathologic parameters and survival after resection. RESULTS: A total of 117 cases of PDAC were included in the study. High ZEB1 expression in cancer cells and in stromal cancer-associated fibroblasts was associated with poor prognosis. There was also a trend for poor prognosis with a lymph node ratio of greater than 0.10. In line with its role as an inducer of epithelial-mesenchymal transition, ZEB1 expression in cancer cells was positively correlated with Vimentin expression and negatively with E-Cadherin expression. In multivariate analysis, stromal ZEB1 expression grade was the only independent factor of survival after resection. CONCLUSION: Our data suggest that ZEB1 expression in cancer cells as well as in stromal fibroblasts are strong prognostic factors in PDAC. Stromal ZEB1 expression is identified for the first time as an independent predictor of survival after resection of PDAC. This observation suggests that therapies targeting ZEB1 and its downstream pathways could hit both cancer cells and supporting cancer-associated fibroblasts.