Abstract: Pancreatic ductal adenocarcinoma (PDAC) is a rarely highly malignant disease, with a poor prognosis and a low survival rate. PDAC with its characteristics of stealth clinical manifestation, rapid disease development and poor prognosis, is hard to be diagnosed at an early stage. Thus, the lethality of PDAC ranks top four in many countries. The 5-year survival rate of the patients with PDAC was only between 2-6%, which is the lowest in all kinds of cancer. Surgery is the main treatment method, but it is hard to stop the progress of the disease completely. As the technology of radical surgery becoming mature, and the adjuvant radiochemotherapy becoming common, the postoperative 5-year survival rate of the patients with PDAC in our hospital was up to about 10%, and the median survival time was up to 30 months. According to our long-term follow-up results, some patients with the same pathological diagnosis did survive much longer than the others after the same radical operation. Therefore, we separated those patients into two groups (postoperative survival duration <1 year, and ≥5 years), and detected their cancer samples through whole genome sequencing. In the aspect of clinical situation, the level of CA19-9, as a good predictor, was much higher in the short-survival group than that in the long-survival group before surgical treatments (P<0.001). Positive lymph nodes rate was also much higher in the short-survival group than that in the long-survival group (P<0.001), which indicated the capability of potential metastasis of the tumor mass. In the aspect of basic medicine, Lamp2, Tmem219, TTI2, Rdm1, Ppp2ca, Ezr, Serpini2, and Cep85, were detected to have the most important mutations between these 2 groups, as well as Twist1, Ywhaz, Sqstm1, Gna13, Lrig1, and Myc, were proved to have the most significant changes in their expression levels. Experiments in vitro and vivo had confirmed these findings, and the most crucial genes related to the postoperative survival of patients with PDAC emerged.
