Acute-phase protein response and survival duration of patients with pancreatic cancer

Abstract

Background. Current methods to predict survival duration of patients with pancreatic cancer are limited. The aim of this study was to determine whether certain nutritional indices and the acute‐phase protein response are prognostic factors independent of disease stage for patients with unresectable pancreatic cancer. Methods. Variables at the time of diagnosis of 102 patients with unresectable pancreatic cancer were entered into a Cox's proportional hazards model. Included in the analysis were the serum concentration of C‐reactive protein (CRP) and albumin, the extent of weight loss, age, sex, and disease stage (International Union Against Cancer criteria). Results. A multivariate analysis in which each factor was adjusted for the influence of the other factors revealed the patient age, disease stage, serum albumin, and serum CRP to be independent predictors of survival. The presence of an acute‐phase protein response was the most significant independent predictor of survival duration. The median survival of those with an acute‐phase protein response (CRP > 10 mg/L, n = 45) was 66 days compared with 222 days for those with no acute‐phase protein response (n = 57, P = 0.001, Mann‐Whitney U test). Conclusion. The acute‐phase protein response is a useful prognostic indicator for patients with unresectable pancreatic cancer. Moreover, the metabolic disturbances associated with an acute‐phase protein response of patients with pancreatic cancer may be a worthwhile therapeutic target.

Elevated tumour interleukin-1β is associated with systemic inflammation: a marker of reduced survival in gastro-oesophageal cancer

“…An APPR has been well documented among patients with cancer, including gastric and oesophageal malignancies, and an elevated serum CRP has been identified as an adverse prognostic indicator, independent of stage of disease, among these patients (Rashid et al, 1982;Falconer et al, 1995;Kodama et al, 1999;McMillan et al, 2001McMillan et al, , 2003Nozoe et al, 2001;Forrest et al, 2003). The present study has confirmed these findings.…”

“…Systemic inflammation has been found in association with the majority of advanced solid epithelial malignancies and at the time of diagnosis up to 50% of patients may have an elevated acute phase protein response (APPR) (Falconer et al, 1995). The presence of an APPR has been associated with weight loss, the presence of hypermetabolism and anorexia, extent of disease, the development of recurrence in advanced cancer, and adverse prognosis (independent of stage of disease) (Rashid et al, 1982;Kodama et al, 1999;McMillan et al, 2001McMillan et al, , 2003Nozoe et al, 2001;Forrest et al, 2003).…”

Metabolic disturbance and sensitivity to endotoxin in patients with advanced cancer: relationship to lymphocyte reactivity, tumour necrosis factor (TNF) production and survival

“…The magnitude of the acute-phase protein response in patients with metastatic colorectal cancer correlated with reduced survival in the present study and in previous studies of patients with other tumours [31]. Patients and volunteers showed similar TNF production and cell concentrations, and neither variable correlated with the presence or magnitude of the acute-phase protein response, and failed to separate the diverse groups in terms of outcome.…”

Systemic inflammatory response predicts outcome in patients undergoing resection for ductal adenocarcinoma head of pancreas

“…An elevated C-reactive protein concentration has previously been shown to have independent prognostic value in patients with unresectable pancreatic ductal adenocarcinoma (Falconer et al, 1995;Ueno et al, 2000;Engelken et al, 2003). However, to our knowledge the prognostic value of C-reactive protein has not been previously examined in patients with operable disease.…”