Preoperative fecal elastase-1 is used as predictive prognostic marker of pancreatic adenocarcinoma

Abstract

Introduction: The clinical relevance of the fibrosis regarding tumor progression is supported by the correlations seen between poor outcome. Pancreas cancer has a massive fibrotic stoma which contributes to the local inflammatory environment. Pancreatic fibrosis is thought to be responsible for occlusion of the pancreatic duct by a tumor, chronic inflammation of the tumor, or by chronic pancreatitis. Fecal elastase-1 level has been used to assess moderate to severe exocrine dysfunction of the pancreas and predict pancreas fibrosis. The aim of this study was to assess the impact of fecal elastase on the prognosis of pancreas cancer patients. Methods: Between January 2006 and December 2014, 134 patients with pancreatic adenocarcinoma underwent R0 resection at Gangnam Severance Hospital, Seoul, Korea. Patients were classified into two groups according to the preoperative Fecal elastase; “normal” (fecal elastase-1: ≥200 μg/g), “reduced” (fecal elastase-1: <200 μg/g). We evaluated disease free Survival (DFS) and overall survival (OS). Results: Median preoperative fecal elastase-1 level was 188.92 μg/g (5.5–753.00). 49 Patients had reduced pancreatic function, 29 patients had normal pancreatic function. Median Disease free survival (DFS) was 16.29 months (2–103). Two groups had significantly different DFS (p < 0.001). In the multivariate analysis, normal fecal elastase-1 level and early T stage was found to be an independent prognostic factor for DFS and OS (p < 0.01, p < 0.01 respectively). Conclusion: Pancreas fibrosis is a significant, unfavourable prognostic factor for pancreas cancer after curative resection. Fecal elastase-1 is simple and non invasive predictive clinical marker for prognosis of pancreatic cancer.