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Pancreatic ductal adenocarcinoma (PDAC) is the ninth most common human malignancy and the sixth leading cause of cancer-related death in China.AcK27-HOXB9 is a newly identified HOXB9 post-transcriptional modification that can predict the outcome in lung adenocarcinoma and colon cancer well.However,the role of AcK27-HOXB9 in PDAC is unclear.The present study aims to investigate the differential diagnostic role of patients with AcK27-HOXB9 PDAC.Tissue microarrays consisting of 162 pancreatic tumor tissue samples from patients with PDAC and paired normal subjects were used to examine HOXB9 and AcK27-HOXB9 levels and localizations by immunohistochemical analysis and Weste blot assay,respectively.HOXB9 was upregulated (P < 0.0001),and AcK27-HOXB9 (P=0.0023) was downregulated in patients with PDAC.HOXB9 promoted (P =0.0115),while AcK27-HOXB9 (P=0.0279) inhibited PDAC progression.AcK27-HOXB9 predicted favorable outcome in patients with PDAC (P=0.0412).AcK27-HOXB9 also suppressed PDAC cell migration in a cell migration assay.The results of this study showed that HOXB9 promoted and AcK27-HOXB9 suppressed PDAC progression.The determination of ratio between HOXB9 and AcK27-HOXB9 exhibited potential diagnostic value in patients with PDAC.