The Chinese Society of Clinical Oncology (CSCO) has issued an expert consensus that aims to standardize molecular testing in pancreatic ductal adenocarcinoma (PDAC), a disease marked by relentless progression and a dismal prognosis. PDAC accounts for roughly 95% of primary pancreatic malignancies, yet outcomes remain poor, particularly for patients presenting with metastatic disease, where long-term survival stays below 5%. Against this backdrop, CSCO’s latest guidance reflects the accelerating shift toward precision oncology in routine pathology.
At the core of the document is the recommendation that clinicians incorporate comprehensive genetic and molecular assessment into the diagnostic workflow using tissue or cytology specimens. The panel emphasizes that the goal is not simply classification, but actionable decision-making—supporting both targeted therapies and immunotherapy selection based on clinically relevant biomarkers.
The consensus highlights key molecular targets commonly evaluated in PDAC. Alterations in genes such as KRAS and actionable DNA-repair pathways (including BRCA-related mechanisms) can influence eligibility for targeted strategies. It also outlines testing for mismatch repair deficiency and microsatellite instability (MSI), which may identify tumors more likely to respond to immune checkpoint blockade.
Beyond single-gene biomarkers, the expert group underscores the heterogeneity of PDAC and the value of molecular subtyping derived from genomic analyses. Large-scale studies using whole-genome sequencing have demonstrated that PDAC can be partitioned into distinct molecular categories with differing biological features and potential clinical implications. Translating this complexity into testing algorithms, however, remains a practical challenge—hence the consensus’s focus on evidence-based, implementable recommendations.
CSCO further addresses the growing role of liquid biopsy, framing it as a complementary approach when tissue is limited or when dynamic monitoring is needed. By enabling detection of tumor-derived genetic changes in blood, liquid biopsy may extend access to precision information over the course of treatment.
Finally, the consensus connects molecular findings with precision imaging concepts to refine treatment planning. The overarching message is that integrated molecular diagnostics—paired with imaging and clinical context—can help close the gap between tumor biology and therapeutic targeting.
This consensus is published in British Journal of Cancer and serves as an authoritative reference intended to improve consistency, feasibility, and clinical relevance of PDAC molecular testing across care settings.
Subject of Research: Precision testing and molecular diagnosis in pancreatic cancer (PDAC)
Article Title: Chinese expert consensus on precision testing and molecular diagnosis of pancreatic cancer (2025)
Article References: Cao, D., Wu, J., Cui, J. et al. (2026) Br J Cancer. https://doi.org/10.1038/s41416-026-03522-x
DOI: https://doi.org/10.1038/s41416-026-03522-x
Keywords: pancreatic ductal adenocarcinoma; molecular testing; CSCO; KRAS; BRCA; MSI; liquid biopsy; precision oncology; immunotherapy
