Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer

Abstract

BackgroundThe relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown. AimTo investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer. Methods194 patients with advanced pancreatic cancer were prospectively enrolled between 2007 and 2009 and underwent faecal elastase-1 measurement. Exocrine pancreatic secretion was defined as “moderately reduced” (faecal elastase-1: 100–200μg/g), “severely reduced” (faecal elastase-1<100 and >20μg/g) and “extremely reduced” (faecal elastase-1≤20μg/g). ResultsMedian faecal elastase-1 was 204μg/g (interquartile range 19; 489). Overall, 48 patients (25%) had an extremely reduced exocrine pancreatic secretion, 28 (14%) a severely reduced exocrine pancreatic secretion and 21 (11%) a moderately reduced exocrine pancreatic secretion. Patients with extremely reduced exocrine pancreatic secretion had higher rates of pancreatic head localizations (P<0.01) and of jaundice (P<0.01). Median overall survival was 10.5months. Patients with faecal elastase-1≤20μg/g had a worse prognosis (median survival: 7 versus 11months, P=0.031). Presence of metastases (Hazard ratio 1.81, P<0.0001), haemoglobin≤12g/L (Hazard ratio 2.12, P=0.001), albumin≤40g/L (Hazard ratio 1.64, P=0.010) and FE-1≤20μg/g (Hazard ratio 1.59 P=0.023) resulted as independent predictors of survival in advanced pancreatic cancer patients. ConclusionsA low value of faecal elastase-1 is strongly correlated with a poor survival in advanced pancreatic cancer.