https://orcid.org/0000-0002-5664-2286
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Abstract
Background
Identification of metastatic pancreatic cancer (mPC) patients with the worst prognosis could help to tailor therapy. We evaluated readily available biomarkers for the prediction of 90-day mortality in a nationwide cohort of mPC patients.
Methods
Patients with synchronous mPC were included from the Netherlands Cancer Registry (2015–2017). Baseline CA19-9, albumin, CRP, LDH, CRP/albumin ratio, and (modified) Glasgow Prognostic Score ((m)GPS composed of albumin and CRP) were evaluated. Multivariable logistic regression analyses were performed to identify predictors of 90-day mortality. Prognostic value per predictor was quantified by Nagelkerke’s partial R2.
Results
Overall, 4248 patients were included. Median overall survival was 2.2 months and 90-day mortality was 59.4% (n = 1629). All biomarkers predicted 90-day mortality in univariable analysis, and remained statistically significant after adjustment for clinically relevant factors and all other biomarkers (all p < 0.001). The prognostic value of the biomarkers combined was similar to WHO performance status. Patients who received chemotherapy had better outcomes than those who did not, regardless of biomarker levels.
Conclusions
In mPC patients, albumin, CA19-9, CRP, LDH, CRP/albumin ratio, and (m)GPS are prognostic for poor survival. Biomarkers did not predict response to chemotherapy. These readily available biomarkers can be used to better inform patients and to stratify in clinical trials.
Acknowledgements
The authors thank the registration team of the Netherlands Comprehensive Cancer Organization (IKNL) for the collection of data for the Netherlands Cancer Registry.
Ethics approval
The Medical Ethics Committee of the Amsterdam UMC, University of Amsterdam waived the need for ethical approval. The study was performed in accordance with the Declaration of Helsinki.
Presentations
This study was presented during the 13th Congress of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA), Amsterdam 2019.
Author contributions
Study design: MS, EvV, LvdG, MFB, JWW, MGB, HvL. Data acquisition and statistical analysis: MS, EvV, LvdG, MFB, JWW, EWS, MGB, HvL. Manuscript preparation: MS, EvV, LvdG, MGB, HvL. Revising the manuscript: LvdG, ORB, MFB, NHM, MYH, JvH, JV, JdVG, JWW, EWS. Supervision: JWW, EWS, MGB, HvL.
Disclosure statement
NHM has acted as a consultant for BMS, Eli Lilly, MSD, Servier, and Astra Zenenca. MFB has received research funding from Celgene and acted as a consultant for Servier. HWL has acted as a consultant for BMS, Celgene, Eli Lilly and Company, Nordic Pharma Group, Philips and Servier, has received research grants from, Amgen, Bayer Schering Pharma AG, BMS, Celgene, Eli Lilly and Company, GlaxoSmithKline Pharmaceuticals, Nordic Pharma Group, Philips, Roche Pharmaceuticals. JDV has received non-financial support from BTG, and Servier, and has served as a consultant for Shire and has received institutional research funding from Servier. The other authors report no conflict of interest.
Data availability statement
This is a retrospective study for which data were derived from the Netherlands Cancer Registry (NCR). All relevant data are available within the manuscript.