What does this research mean for the field?

Stringent Claudin 18.2 positivity thresholds (≥75% and ≥40%) identify nearly identical candidate populations for targeted therapy in pancreatic ductal adenocarcinoma, whereas relaxing the threshold to any detectable expression (≥5%) substantially increases the eligible patient pool. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate how different immunohistochemical positivity thresholds for Claudin 18.2 influence patient eligibility for targeted therapies in pancreatic ductal adenocarcinoma.

September 3, 2026CancersOpen Access

Claudin 18.2 Positivity Thresholds and Candidate Populations for Targeted Therapy in Pancreatic Ductal Adenocarcinoma: A Real-World Retrospective Cohort

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To evaluate how different immunohistochemical positivity thresholds for Claudin 18.2 influence patient eligibility for targeted therapies in pancreatic ductal adenocarcinoma.
Retrospective single-center study evaluating Claudin 18.2 (CLDN18.2) expression by immunohistochemistry (clone 43-14A) in 99 patients with pancreatic ductal adenocarcinoma (metastatic, n = 71; non-metastatic, n = 28).
Evaluated candidate populations across three thresholds: two trial cutoffs (≥40% any intensity and ≥75% moderate-to-strong intensity) and an exploratory cutoff (≥5% any intensity), paired with exploratory survival analyses.
Candidate proportions across the full cohort were 40.4% (40/99) at ≥75%, 43.4% (43/99) at ≥40%, and 64.6% (64/99) at ≥5%; in metastatic disease, proportions were 36.6%, 38.0%, and 59.2%, respectively.
Lowering the cutoff from ≥75% to ≥40% reclassified only 1.4% (1/71) of metastatic patients (McNemar p = 1.0), whereas lowering to ≥5% reclassified 22.5% (16/71; 95% CI, 14.4–33.5; p < 0.001).
No association was detected between CLDN18.2 expression and overall or progression-free survival across any threshold based on exploratory analyses of 52 deaths.

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Implication

Retrospective cohort study reveals standard clinical trial thresholds identify similar candidate pools in pancreatic ductal adenocarcinoma, indicating need for tumor-specific criteria.

Cite This Study

Akgüner et al. (2026) studied this question.

synapsesocial.com/papers/6a993600636c6408cfa7ec40 https://doi.org/10.3390/cancers18172827

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Implication

Retrospective cohort study reveals standard clinical trial thresholds identify similar candidate pools in pancreatic ductal adenocarcinoma, indicating need for tumor-specific criteria.

Claudin 18.2 Positivity Thresholds and Candidate Populations for Targeted Therapy in Pancreatic Ductal Adenocarcinoma: A Real-World Retrospective Cohort

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Discussion

Implication

Cite This Study

Claudin 18.2 Positivity Thresholds and Candidate Populations for Targeted Therapy in Pancreatic Ductal Adenocarcinoma: A Real-World Retrospective Cohort

Key Points

Discussion

Implication

Cite This Study

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