Background: Pancreatic cancer is a devastating disease, being the fourth cause of cancer-related death worldwide. Several studies have investigated the use of multiple cancer biomarkers, such as C 19-9, CA 125, and CEA, as prognostic factors for overall survival in pancreatic cancer. CA 125 seems to have superior predictive utility in selected groups of PDAC patients. Material and methods: We retrospectively analyzed data collected from 129 patients admitted to our Department due to diagnosis with pancreatic cancer. Prior to the survival analysis, the preliminary assessment of pre-treatment levels of biomarkers was carried out. The overall survival time was defined as that elapsing from the admission date to the date of death. Results: The patients mean age was 62 +/- 9.5 years, while the median overall survival (OS) was 7mo 12d. As for tumor localization, most of the patients had PDAC within the head of the pancreas (n=93), followed by PDAC of the pancreatic body (n=15), pancreatic tail (n=14) and both pancreatic body and tail (n=7). Ninety-five patients had an unresectable tumor and 34 were diagnosed with a resectable tumor (tab.1). The statistically significant correlation was found for CA 125 (ρ=-0.355 p<0.001) and CA 19-9 (ρ=-0.225 p=0.012). We chose the following cut-off points: CA 125>=20 IU/mL was considered as high, and CA 19-9>=200 IU/mL as significantly elevated. In the univariate analysis in the Kaplan-Meier survival model, adjusted for age, both elevated biomarkers were statistically significant prognostic factors of OS (CA 125<20 median OS- 10mo 3d vs. CA 125>=20- 4mo 17d p=0.001) and (CA19-9<200 median OS- 8mo 3d vs. CA 19-9>=200- 4mo 20d p=0.001). Patients’ gender and, PDAC resectability and its localization were not statistically significant prognostic factors (log rank test p=0.8; p=0.108 and p=0.578 respectively). In the age-adjusted multivariate analysis, both biomarkers remained significant- CA 125>=20 (HR: 1.73 95%CI 1.27-2.58 p=0.006) CA 19-9>=200 (HR: 1.78 95%CI 1.19-2.66 p=0.005) Conclusions: Our study proves the utility of the pretreatment assessment of CA 125 because its level is tightly correlated with OS. It may be hypothesized that the pretreatment measurement of both CA 19-9 and CA 125 can provide the valuable information about patients’ prognosis.

Objective: Pancreatic adenocarcinoma (PDAC) and mass forming chronic pancreatitis (CP) can be easily misdiagnosed due to their resemblances in clinical, radiological, and biochemical criteria. In our previous study, we reported a very high concentration of D-Dimers in portal blood in patients with pancreatic cancer which may help to differentiate malignant from benign pancreatic tumours. In this study, we aim to describe other portal and peripheral coagulation profiles of PDAC in comparison to CP patients, as well to test the hypothesis; thus, it is possible to distinguish pancreatic malignancy and benign tumour based on these parameters. Methods: We included retrospectively 115 patients with the absence of venous thromboembolism (VTE), qualified to surgical treatment due to pancreatic tumours, both PDAC and CP. Patients underwent surgery in General and Transplant Surgery Unit of Medical University of Lodz between December 2011 and February 2014. Patients with distant metastases diagnosed before or during the surgery were excluded. The coagulation profile, which includes fibrinogen, activated partial thromboplastin time (aPTT), prothrombin time (PT), and thrombin time (TT), was determined in blood samples from the portal and peripheral vein taken intraoperatively. Results: The fibrinogen level was higher and the aPTT index shortened in the peripheral and portal blood of the PDAC group, which reflects the well-known link between PDAC and general hypercoagulability. Furthermore, these effects are sex-specific. The mean age in the CP group was lower than in the PDAC group (54.63 ± 12.37 vs. 63.77 ± 3.23, p < 0.001) and correlated with the fibrinogen distribution in male patients with CP (portal r = 0.34; p = 0.07; peripheral r = 0.39; p = 0.04). We calculated sex-specific logistic regression models (male: peripheral aPTT and age, AUC: 0.795, female: portal fibrinogen and age, AUC: 0.805), both maintaining the good discrimination properties after V-fold cross validation (0.759, 0.742). Conclusions: Our study shows that the differences between coagulation profiles in PDAC and CP patients not only seems to be a reflection of gender-specific biological features, but also helps to discriminate between them. The main goal of the study was to explore the biology of pancreatic cancer and lay a solid base for further investigations of PDAC biomarkers. This paper is the first to describe the detailed coagulation profile in portal blood in patients with pancreatic solid tumors. At present, the clinical application of our results is not clear; however, we hope that it may improve our understanding of this complex disease.