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Li JQ, Zhao HG, Cai HQ. Epigenetic-immune landscape of pancreatic ductal adenocarcinoma: From tumor biology to multimodal treatment in the surgical setting. World J Gastrointest Surg 2026; 18(11): 125757 [DOI: 10.4240/wjgs.125757]
World J Gastrointest Surg. Nov 27, 2026; 18(11): 125757 Published online Nov 27, 2026. doi: 10.4240/wjgs.125757
Epigenetic-immune landscape of pancreatic ductal adenocarcinoma: From tumor biology to multimodal treatment in the surgical setting
Jun-Qi Li, Hong-Guang Zhao, Hong-Qiao Cai
Jun-Qi Li, Hong-Qiao Cai, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Hong-Guang Zhao, Department of General Surgery, Changchun Children’s Hospital, Changchun 130000, Jilin Province, China
Author contributions: Li JQ contributed to the discussion and design of the manuscript; Zhao HG contributed to the writing and editing of the manuscript, and review of the literature; Cai HQ designed the overall concept and outline of the manuscript; and all authors thoroughly reviewed and endorsed the final manuscript.
AI contribution statement: Portions of this manuscript were edited using AI tools solely for language refinement. The authors carefully reviewed and verified all AI-assisted outputs and take full responsibility for the scientific content of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Hong-Qiao Cai, MD, PhD, Associate Professor, Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, The First Hospital of Jilin University, No. 1 Xinmin Street, Changchun 130021, Jilin Province, China. hongqiaocai@jlu.edu.cn
Received: July 16, 2026 Revised: August 14, 2026 Accepted: September 18, 2026 Published online: November 27, 2026 Processing time: 119 Days and 23.3 Hours
Core Tip
Core Tip: This article highlights the important interplay between epigenetic alterations and the immune microenvironment. We summarize the roles of DNA methylation, histone modification, and non-coding RNAs in regulating immune checkpoints, macrophages, myeloid-derived suppressor cells, and regulatory T cells, all of which contribute to an immunosuppressive tumor microenvironment. We also discuss therapies combining epigenetic modulators with immune checkpoint inhibitors in the surgical setting. Furthermore, we explore advances in multi-omics technologies that deepen our understanding of epigenetic-immune crosstalk. Ultimately, we emphasize targeting the epigenetic-immune axis as a strategy to enhance anti-tumor immunity and improve patient outcomes.
