Readily available biomarkers predict poor survival in metastatic pancreatic cancer

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. 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. 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 <i>p</i> 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.

识别预后最差的转移性胰腺癌（metastatic pancreatic cancer, mPC）患者，有助于实现个体化治疗方案的定制。本研究针对全国范围内的mPC患者队列，评估了可便捷获取的生物标志物对90天死亡率的预测价值。研究纳入2015至2017年荷兰癌症登记系统中确诊为同步性转移性胰腺癌的患者，对患者基线水平的糖链抗原19-9（CA19-9）、白蛋白、C反应蛋白（CRP）、乳酸脱氢酶（LDH）、CRP/白蛋白比值以及（改良）格拉斯哥预后评分（(modified) Glasgow Prognostic Score, (m)GPS，由白蛋白与CRP构成）进行了评估。采用多变量logistic回归分析筛选90天死亡率的预测因子，并通过内格尔克克偏R²（Nagelkerke’s partial R²）量化各预测因子的预后价值。本研究共纳入4248例患者，患者的中位总生存期为2.2个月，90天死亡率为59.4%（共1629例）。单变量分析显示，所有生物标志物均能预测90天死亡率；在校正临床相关因素及其他所有生物标志物后，其预测价值仍具有统计学意义（所有p < 0.05）。在mPC患者中，白蛋白、CA19-9、CRP、LDH、CRP/白蛋白比值及(m)GPS均与不良生存预后相关。上述生物标志物无法预测患者对化疗的应答情况。这些易于获取的生物标志物可用于更全面地为患者提供病情告知，并用于临床试验中的患者分层。