High tissue factor (tf) expression in pancreatic cancer correlates with worse outcomes, offering a vital tool for patient selection.

• High tf was noted in 17.4% of cases, linked to elevated CA19-9 and shorter survival (median: 20.6 months vs. 38.8 months in low tf).
• It served as an independent poor prognosis predictor (hazard ratio: 2.21).

Surgeons should consider tf expression when assessing tumor aggressiveness and tailoring treatment strategies.

• Tf-negative tumors are associated with better long-term survival despite recurrence.