Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer

BackgroundThe relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown.AimTo investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer.Methods194 patients with advanced pancreatic cancer were prospectively enrolled between 2007 and 2009 and underwent faecal elastase-1 measurement. Exocrine pancreatic secretion was defined as “moderately reduced” (faecal elastase-1: 100–200 μg/g), “severely reduced” (faecal elastase-1 < 100 and >20 μg/g) and “extremely reduced” (faecal elastase-1 ≤ 20 μg/g).ResultsMedian faecal elastase-1 was 204 μg/g (interquartile range 19; 489). Overall, 48 patients (25%) had an extremely reduced exocrine pancreatic secretion, 28 (14%) a severely reduced exocrine pancreatic secretion and 21 (11%) a moderately reduced exocrine pancreatic secretion. Patients with extremely reduced exocrine pancreatic secretion had higher rates of pancreatic head localizations (P < 0.01) and of jaundice (P < 0.01). Median overall survival was 10.5 months. Patients with faecal elastase-1 ≤ 20 μg/g had a worse prognosis (median survival: 7 versus 11 months, P = 0.031). Presence of metastases (Hazard ratio 1.81, P < 0.0001), haemoglobin ≤ 12 g/L (Hazard ratio 2.12, P = 0.001), albumin ≤ 40 g/L (Hazard ratio 1.64, P = 0.010) and FE-1 ≤ 20 μg/g (Hazard ratio 1.59 P = 0.023) resulted as independent predictors of survival in advanced pancreatic cancer patients.ConclusionsA low value of faecal elastase-1 is strongly correlated with a poor survival in advanced pancreatic cancer.