Vimentin expression as a prognostic marker in pancreatic cancer: a systematic review and meta-analysis

Background Vimentin, a key component of the epithelial-to-mesenchymal transition (EMT), has been mechanistically implicated in the progression and poor prognosis of pancreatic ductal adenocarcinoma (PDAC). However, clinical studies investigating the prognostic significance of tumor-cell vimentin expression have yielded inconsistent results. This systematic review and meta-analysis aimed to precisely quantify the association between vimentin expression and key clinicopathological features, including overall survival (OS), tumor stage, lymph node status, and distant metastasis. Methods A systematic search was conducted across PubMed, Web of Science, and Scopus, published before July 8th, 2025, yielding 443 articles. Following duplicate removal and two rounds of independent screening using Rayyan by two reviewers, with non-concordance resolved by a third, a total of nine articles met the inclusion criteria for the meta-analysis. Pooled effect sizes were calculated using Hazard Ratios (HRs) for OS and Odds Ratios (ORs) with 95% Confidence Intervals (CIs) for categorical outcomes. Heterogeneity was assessed using the I 2 statistic and Q -test, and publication bias was evaluated via funnel plot symmetry. Results We demonstrated a statistically significant association between tumor-cell vimentin expression and reduced OS [pooled logHR = 1.39, 95% CI: (0.11, 2.68), p = 0.034], although high heterogeneity was observed ( I 2 = 93.64%, p < 0.001). Crucially, vimentin expression was also significantly associated with a higher lymph node stage [N-stage; pooled logOR = 0.58, 95% CI (0.08, 1.08), p = 0.022], with negligible heterogeneity ( I 2 = 0%, p = 0.418). In contrast, no significant association was found between vimentin expression and either primary T-stage [pooled logOR = −0.10, 95% CI: (−0.87, 0.66), p = 0.791] or M-stage [pooled OR = 0.08, 95% CI: (−0.95, 1.10), p = 0.882]. Publication bias was minimal for the N and T stages, but notable asymmetry was observed for the OS analysis. Conclusion While tumor-cell vimentin expression is significantly associated with poorer OS and lymph node involvement, high heterogeneity and potential publication bias necessitate caution. Current evidence suggests vimentin is a promising prognostic indicator, but its clinical utility as a standalone biomarker remains limited by a lack of methodological standardization. Systematic Review Registration PROSPERO 2025 CRD420251127404. Available from https://www.crd.york.ac.uk/PROSPERO/view/CRD420251127404 .