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The efficacy of preoperative neoadjuvant chemoradiotherapy ( NAC ) in cases of pancreatic cancer with extremely poor prognoses has been reported. In this study, we aimed to identify novel biomarkers that reflect prognoses following chemoradiotherapy using tertiary lymphoid organs ( TLO ) expressed in the tumor microenvironment. Resected tumor specimens were obtained from 140 pancreatic cancer patients. We retrospectively investigated the clinical relevance of  TLO  by categorizing patients into those who underwent upfront surgery (surgery first [ SF ]) and those who received NAC. The immunological elements within  TLO  were analyzed by immunohistochemistry ( IHC ). In the  IHC  analysis, the proportions of  CD 8+ T lymphocytes,  PNA d+ high endothelial venules,  CD 163+ macrophages and Ki‐67+ cells within the  TLO  were higher in the  NAC  group than in the  SF  group. In contrast, the proportion of programmed cell death‐1+ immunosuppressive lymphocytes within  TLO  was lower in the  NAC  group than in the  SF  group. The  NAC  group demonstrated favorable prognoses compared with the  SF  group. In the multivariate analysis, the  TLO /tumor ratio was determined as an independent predictive prognostic factor. In conclusion, the administration of preoperative chemoradiotherapy may influence the immunological elements in the tumor microenvironment and result in favorable prognoses in pancreatic ductal adenocarcinoma patients.

Prognostic relevance of tertiary lymphoid organs following neoadjuvant chemoradiotherapy in pancreatic ductal adenocarcinoma