Stroma-nerve axis in pancreatic ductal adenocarcinoma: Bidirectional regulatory mechanisms and clinical translation hypothesis

Figure 3 Proposed research pathway for the Stroma-Nerve Axis Activity Score. The schematic outlines a stepwise framework from concept generation and definition of key stroma-nerve axis (SNA) dimensions through biomarker and data collection (pathology/immunohistochemistry, multiomics, and clinical outcomes) to the statistical/model-based construction of a SNA Activity Score prototype. Subsequent validation in independent cohorts and exploratory SNA-informed clinical trials (e.g., SNA-high vs SNA-low stratification) are illustrated. SNA Activity Score is presented as a conceptual research tool, and this pathway is intended for model development and hypothesis testing rather than immediate clinical decision-making. SNAAS: Stroma-Nerve Axis Activity Score; SNA: Stroma-nerve axis; CAF: Cancer-associated fibroblasts; ECM: Extracellular matrix; IHC: Immunohistochemistry.