The Lipase/Amylase Ratio (LAR) in Peripheral Blood Might Represent a Novel Prognostic Marker in Patients with Surgically Resectable Pancreatic Cancer.

Michael Stotz,Karoline Lackner,Martin Pichler,Armin Gerger,Georg C Hutterer,Peter Kornprat,Eva Asamer,Herbert Stöger,Eva V Klocker,Jakob M Riedl,Felix Prinz,Dominik A Barth

doi:10.3390/cancers12071798

Michael Stotz, Karoline Lackner + Show 10 more

Open Access

https://doi.org/10.3390/cancers12071798

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Abstract

Pancreatic enzymes might play a pivotal role in the pathophysiology and prognosis of pancreatic cancer. The aim of this study is to investigate the lipase/amylase ratio (LAR), representing a marker previously used in the differentiation of pancreatitis, as a potential prognostic marker in pancreatic cancer. Data from 157 surgically treated patients with ductal pancreatic adenocarcinoma and 351 patients with metastatic disease were evaluated retrospectively. Cancer-specific survival (CSS) was considered the endpoint of the study. After applying Kaplan–Meier curve analysis, uni- and multivariate Cox regression models were calculated to evaluate the prognostic relevance of LAR. An elevated LAR at diagnosis of localized pancreatic cancer was significantly associated with higher CA19-9 levels (p < 0.05). In univariate analysis, we observed an increased LAR as a significant factor for lower CSS in localized pancreatic cancer patients (HR = 1.63; 95% CI = 1.12–2.36; p = 0.01), but not in metastatic patients (HR = 1.12; 95% CI = 0.87–1.43; p = 0.363). In multivariate analysis, including age, gender, tumor stage, Karnofsky Performance Status, tumor grade, administration of chemotherapy and the LAR, an increased LAR was confirmed to represent an independent prognostic factor regarding CSS (HR = 1.81; 95% CI = 1.17–2.77; p = 0.007) in localized pancreatic cancer patients. In conclusion, our study identified the LAR as an independent prognostic factor in surgically treated pancreatic cancer patients.

Highlights

Despite tremendous advances regarding various treatment modalities over the recent years, pancreatic cancer remains to represent an exceptionally aggressive tumor entity with high mortality rates
The ESPAC 4 randomized phase III trial, analyzing 730 resected pancreatic cancer patients, has been able to show a benefit of gemcitabine plus capecitabine, and recently the modified FOLFIRINOX regimen has entered the stage as a new adjuvant standard of care treatment
Parameters included in the lipase/amylase ratio (LAR) that further documented clinico-pathological data included the administration of chemotherapy with gemcitabine, as well as age and gender of the patients included in the study

Summary

Introduction

Despite tremendous advances regarding various treatment modalities over the recent years, pancreatic cancer remains to represent an exceptionally aggressive tumor entity with high mortality rates. Notwithstanding intensive research efforts and the introduction of novel therapeutic agents, the prognosis of pancreatic cancer has only slightly improved over the last years [1]. This is for the most part due to a late onset of symptoms, usually resulting in undetected pronounced. The ESPAC 4 randomized phase III trial, analyzing 730 resected pancreatic cancer patients, has been able to show a benefit of gemcitabine plus capecitabine, and recently the modified FOLFIRINOX regimen has entered the stage as a new adjuvant standard of care treatment. The combination therapy of gemcitabine plus nab-paclitaxel failed to demonstrate a significant progression-free survival benefit in >860 resected pancreatic cancer patients in the APACT III trial [12]

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