Finally, we investigated the expression pattern of these risk genes within the TME of PACA and discovered that SPOCK2 was specifically and highly expressed in CD8TEX cells in numerous tumors, including BCC, glioma, KICH, LIHC, NSCLC, OV, PACA, PRAD, and SCC. Here, SPOCK2 is linked to permanent neonatal diabetes mellitus-pancreatic and cerebellar agenesis syndrome.