Abstract
Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer-related deaths among individuals over the age of 50. It is characterized by exceptional aggressiveness and is often diagnosed at an advanced stage, highlighting the importance of assessing prognostic factors. The deep awareness of these factors may help in better prevention and treatment planning, eventually improving the outcomes. Favorable prognostic factors include female gender, low tumor stage, ECOG (Eastern Cooperative Oncology Group) 0-1, lowest ASI (Activated Stroma Index), low-grade tumor budding, age below 40, adequate nutrition, and absence of distant metastases. Conversely, unfavorable prognostic factors include the presence of distant metastases and metastases into lymph nodes, high tumor stage, LVI (lymphovascular invasion), PNI (perineural invasion), tumor size above 3 cm, invasion into vessels, higher G grade, higher ASI, high-grade tumor budding, more than 1 CTC (circulating tumor cells) in the bloodstream, ECOG 3-4, age above 40, Black ethnicity, malnutrition, and sarcopenia. This review discusses the prognostic factors of PDAC related to tumor characteristics and the patient's clinical issues. The aim of this review is to synthesize current evidence on prognostic determinants in PDAC, with particular attention to both tumor characteristics and patient-specific clinical features. To achieve this, a comprehensive literature review was performed using PubMed, BrowZine Library, Cochrane Library, SpringerLink, Wiley Online Library, BMJ Journals, and Google Scholar. Relevant studies addressing established and emerging prognostic markers were critically analyzed to provide an updated overview of factors that may influence survival and treatment outcomes. By integrating available data, this review seeks not only to summarize classical prognostic variables but also to highlight novel and underrecognized markers that may hold future clinical relevance. Such an approach may contribute to the refinement of prognostic models, support more accurate patient counseling, and ultimately aid in the optimization of therapeutic strategies for individuals affected by PDAC.