• Biomarkers
• PDAC
• Stroma
• Survival
• WGCNA

• Humans
• Pancreatic Neoplasms/genetics
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/metabolism
• Prognosis
• Biomarkers, Tumor/genetics
• Gene Regulatory Networks
• Gene Expression Regulation, Neoplastic
• Stromal Cells/metabolism
• Stromal Cells/pathology
• Female
• Carcinoma, Pancreatic Ductal/genetics
• Carcinoma, Pancreatic Ductal/pathology
• Carcinoma, Pancreatic Ductal/mortality
• Carcinoma, Pancreatic Ductal/metabolism
• Gene Expression Profiling
• Male
• Transcriptome
• Middle Aged

• ctDNA
• exosomes
• liquid biopsy
• pancreatic cancer

• Humans
• Liquid Biopsy/methods
• Carcinoma, Pancreatic Ductal/diagnosis
• Carcinoma, Pancreatic Ductal/pathology
• Pancreatic Neoplasms/diagnosis
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/genetics
• Biomarkers, Tumor
• Circulating Tumor DNA/blood
• Exosomes/metabolism
• Machine Learning

• Clinical characteristics
• Pancreatic ductal adenocarcinoma
• Prognostic assessment
• Routine blood test indicators
• Tumor markers

• Humans
• Pancreatic Neoplasms/surgery
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/pathology
• Retrospective Studies
• Prognosis
• Male
• Female
• Carcinoma, Pancreatic Ductal/surgery
• Carcinoma, Pancreatic Ductal/blood
• Survival Rate
• Proportional Hazards Models
• Middle Aged
• China/epidemiology
• Aged

• pancreatic cancer
• survival
• survivin

• Humans
• Survivin
• Prognosis
• Inhibitor of Apoptosis Proteins
• Prospective Studies
• Biomarkers, Tumor
• Pancreatic Neoplasms/pathology

• Biomarker
• Cytokine
• Interleukin
• PD-1/PD-L1
• Pancreatic cancer

• Humans
• Biomarkers, Tumor
• Interleukin-10
• Tumor Necrosis Factor-alpha/therapeutic use
• Programmed Cell Death 1 Receptor
• B7-H1 Antigen
• Retrospective Studies
• Interleukin-8
• Pancreatic Neoplasms/pathology
• Carcinoma, Pancreatic Ductal/pathology
• Prognosis
• Adenocarcinoma/pathology
• Pancreatic Neoplasms

• Universitätsklinik München (6933)

• CA19-9
• borderline resectable pancreatic cancer
• neo-adjuvant chemotherapy
• portal vein resection and reconstruction
• venous allograft

• chemotherapy
• colon cancer
• folfox
• iodine-125
• metastasis
• pancreas

• Adenocarcinoma/pathology
• Adenocarcinoma/therapy
• Colonic Neoplasms/pathology
• Colonic Neoplasms/therapy
• Female
• Humans
• Iodine Radioisotopes
• Middle Aged
• Pancreatic Neoplasms/drug therapy
• Quality of Life

• CA 19-9
• NEOLAP
• R0 resection rate
• locally advanced pancreatic cancer
• multiagent induction chemotherapy

• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• CA-19-9 Antigen/therapeutic use
• Humans
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/pathology
• Prognosis
• Prospective Studies

• Biomarker
• Exosomes
• Extracellular vesicles
• Omics
• Pancreatic cancer
• Pathogenesis

• Cell Communication
• Exosomes
• Extracellular Vesicles
• Humans
• Pancreatic Neoplasms

Early detection of pancreatic ductal adenocarcinoma (PDAC) in the general population is difficult due to unknown clinical characteristics. This study was conducted to clarify the factors associated with early stage PDAC. Well-known symptoms and factors associated with PDAC were classified into clinical indicators, risk factors, and imaging findings concomitant with early stage PDAC. To analyze these factors for the detection of patients with early stage PDAC compared to patients without PDAC, we constructed new diagnostic strategies. The factors of 35 patients with early stage PDAC (stage 0 and IA) and 801 patients without PDAC were compared retrospectively. Clinical indicators; presence and number of indicators, elevated pancreatic enzyme level, tumor biomarker level, acute pancreatitis history, risk factors; familial pancreatic cancer, diabetes mellitus, smoking history, imaging findings; presence and number of findings, and main pancreatic duct dilation were significant factors for early stage PDAC detection. A new screening strategy to select patients who should be examined by imaging modalities from evaluating clinical indicators and risk factors and approaching a definitive diagnosis by evaluating imaging findings had a relatively high sensitivity, specificity, and areas under the curve of 80.0%, 80.8%, and 0.80, respectively. Diagnosis based on the new category and strategy may be reasonable for early stage PDAC detection.

Upon diagnosis, about 35% of patients have initially unresectable locally advanced pancreatic cancer. The prognosis of these patients is still poor. Chemotherapy alone has been generally accepted as a standard therapeutic approach. However, clinical decision-making processes have not been established for aggressive treatments such as surgery and chemoradiotherapy in patients with a response and stable case of initially unresectable locally advanced pancreatic cancer. In the current study, we evaluated the reduction rate and duration of carbohydrate antigen (CA) 19-9 within 6 months as long-term survival. Cases of over 44% CA 19-9 reduction only one month from the baseline after treatment were not significantly associated with overall survival. On the other hand, more than 3 months of over 44% CA 19-9 reduction was significantly associated with prognosis, which is the same as the occurrence of distant metastasis. Multidisciplinary treatment focus on local treatment is expected in these selected patients.

A decrease in carbohydrate antigen (CA) 19-9 levels has been proposed as a prognostic marker for survival and recurrence in patients with pancreatic cancer. We evaluated the association between duration of reduced CA 19-9 levels during 6 months after treatment and long-term survival for 79 patients with unresectable locally advanced pancreatic cancer (LAPC). We calculated the differences between pretreatment and monthly CA19-9 levels. We categorized 71 patients with decreases in CA19-9 levels into three groups based on the duration of these reduced levels (>2, >3, and >4 months). The cut-off level for long-term (more than 2 years) survival was identified as a 44% reduction from the baseline, using a ROC curve. A reduction duration >2 months was not associated with overall survival (p = 0.1), while >3 months was significantly associated with survival (p =.04). In multivariate analysis, a reduction duration >3 months predicted a good long-term prognosis (odds ratio = 5.75; 95% confidence interval = 1.47–22.36; p < 0.01). In patients with unresectable LAPC, the duration of reduced CA19-9 levels for more than 3 months, rather than the rate of reduction in CA19-9 levels, during 6 months after treatment was significantly associated with good prognosis.

• CA 19-9
• pancreatic cancer
• prognostic factor

• Chemotherapy
• Multivariate analysis
• Neutrophil-to-lymphocyte ratio
• Pancreatic adenocarcinoma
• Prognosis
• Serum carbohydrate antigen 19-9

• Aged
• Albumins/administration & dosage
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Carcinoma, Pancreatic Ductal/drug therapy
• Carcinoma, Pancreatic Ductal/pathology
• Deoxycytidine/administration & dosage
• Deoxycytidine/analogs & derivatives
• Drug Administration Schedule
• Female
• Fluorouracil/administration & dosage
• Humans
• Irinotecan/administration & dosage
• Kaplan-Meier Estimate
• Leucovorin/administration & dosage
• Male
• Middle Aged
• Neoplasm Metastasis
• Outcome Assessment, Health Care/methods
• Outcome Assessment, Health Care/statistics & numerical data
• Oxaliplatin/administration & dosage
• Paclitaxel/administration & dosage
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/pathology
• Proportional Hazards Models
• Retrospective Studies
• Gemcitabine

• carbohydrate antigen 19-9
• pancreatic head carcinoma
• pancreatoduodenectomy
• prognosis
• γ-glutamyltransferase

• Beijing Municipal Science & Technology Commission, PR China
• Capital’s Funds for Health Improvement and Research, Beijing, PR China

We evaluated preoperative CA 19-9 levels in patients with resected pancreatic cancer to analyze whether they were predictive of clinical outcomes and could help select patients for additional therapy. We hypothesized that elevated CA 19-9 would be associated with worse pathologic findings and oncologic outcomes.

This study assessed 509 patients with non-metastatic pancreatic adenocarcinoma who underwent resection at our institution from 1995-2011 and had preoperative CA 19-9 recorded. No patients received neoadjuvant therapy. CA 19-9 level was analyzed as a continuous and a dichotomized (> vs. ≤ 55 U/mL) variable using logistic and Cox models.

Median follow-up was 7.8 years, and the median age was 66 years (33-90). 64% of patients had elevated preoperative CA 19-9 (median: 141 U/mL), that did not correlate with bilirubin level or tumor size. Most patients had ≥ T3 tumors (72%) and positive lymph nodes (62%). The rate of incomplete (R1 or R2) resection was 19%. Increasing preoperative CA 19-9 was associated with extra-pancreatic extension (p=0.0005), lymphovascular space invasion (p=0.0072), incomplete resection [HR (95% CI) 2.0 (1.2-3.5)], and lower OS [HR = 1.6 (1.3-2.0)]. Each doubling in preoperative CA 19-9 value was associated with an 8.3% increased risk of death [HR = 1.08 (1.02-1.15)] and a 10.0% increased risk of distant recurrence [HR = 1.10 (1.02-1.19)]. Patients classified as non-secretors had comparable outcomes to patients with normal CA 19-9.

Elevated preoperative CA 19-9 level was associated with adverse pathologic features, incomplete resection, and inferior clinical outcomes. Neither tumor size nor bilirubin confound an elevated CA 19-9 level. Preoperative CA 19-9 level may help select patients for additional therapy.

• CA19-9
• neoadjuvant
• pancreatic cancer
• prognostic factors
• resection

There has been growing evidence on the utility of neoadjuvant FOLFIRINOX in borderline resectable (BR) or locally advanced (LA) pancreatic cancer. However, factors predicting survival in these patients remain to be identified, and we aimed to identify these prognostic factors.

Between January 2013 and April 2017, patients with BR or LA pancreatic cancer who received FOLFIRINOX as their initial treatment were identified. Demographic data and clinical outcomes, including the chemotherapy response, conversion to resection, and survival, were reviewed.

A total of 117 patients with BR (n=39) or LA (n=78) pancreatic cancer were included. Of these patients, 29 (24.8%) underwent curative surgery, and R0 resection was achieved in 21 patients (72.4%). The median progression-free survival and overall survival time of all patients were 11.6 and 19.0 months, respectively. In resected patients, the median relapse-free survival and overall survival times were 14.8 and 28.6 months, respectively. In the multivariate Cox model, the lowest level of serum carbohydrate antigen 19-9 (CA 19-9) and resection after FOLFIRINOX were independent factors for improved overall survival. In the subgroup analysis of patients with initial ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) images, the maximum standardized uptake value (SUVmax) of the pancreatic mass was also shown as an independent factor for improved overall survival.

In patients with BR or LA pancreatic cancer, FOLFIRINOX is a valuable neoadjuvant treatment that enables curative surgery in approximately one-quarter of patients and significantly improves overall survival. In these patients, the prognosis can be estimated using the lowest level of serum CA 19-9, operative status, and initial FDG-PET SUVmax.

• FOLFIRINOX
• Neoadjuvant therapy
• Pancreatic neoplasms
• Prognosis
• Survival

• Pancreatic head carcinoma (PHC)
• carbohydrate antigen 19-9 (CA19-9)
• pancreaticoduodenectomy
• prognosis
• total bilirubin

• Pancreatic carcinoma
• prognosis
• risk factors
• surgical procedures
• vascular invasion

Second‐line (2L) chemotherapy after nab‐paclitaxel plus gemcitabine (AG) is important for improving the survival of patients with advanced pancreatic cancer (APC). However, many patients fail to receive 2L chemotherapy because of rapid disease progression. Therefore, early recognition of any ineffectiveness during AG might lead to an increased induction rate of 2L chemotherapy.

We investigated the significance of treatment response at 8 weeks as a predictive factor for the induction of 2L chemotherapy after AG.

From January 2015 to January 2019, 41 patients with APC underwent AG as first‐line chemotherapy at our institute. Thirty‐three patients were evaluated at 8 weeks. Sixteen patients (48%) underwent 2L chemotherapy and 17 (52%) underwent no 2L chemotherapy. Clinical features and treatment response at 8 weeks were, retrospectively, compared among patients. Predictive factors for the induction of 2L chemotherapy were analyzed. Patients with an objective response by 8 weeks received 2L chemotherapy more frequently (P = .026). Decreased CA19‐9 (<50%) at 8 weeks was identified as an independent negative predictive factor for the induction of 2L chemotherapy.

Decreased CA19‐9 (<50%) at 8 weeks may indicate the ineffectiveness of AG and signify that a move to 2L chemotherapy may be required without delay.

• CA19-9
• S-1
• gemcitabine
• nab-paclitaxel
• pancreatic cancer

Background: Pancreatic ductal adenocarcinoma (PDAC) leads to the majority of cancer-related deaths due to its morbidity with similar mortality. Lack of effective prognostic biomarkers are the main reason for belated post-operative intervention of recurrence which causes high mortality. Numerous systematic reviews and meta-analyses have explored the prognostic value of biomarkers in PDAC so far. In this article, we performed an umbrella review analyzing these studies to provide an overview of associations between prognostic biomarkers and PDAC survival outcome and synthesized these results to guide better clinical practice.

Methods: Systematic reviews and meta-analyses investigating the associations between PDAC survival outcomes and prognostic biomarkers were acquired via the PubMed and Embase databases from inception till February 1, 2020. Associations supported by nominally statistically significant results were classified into strong, highly suggestive, suggestive, and weak based on several critical factors such as the statistical significance of summary estimates, the number of events, the estimate of the largest study included, interstudy heterogeneity, small-study effects, 95% predictive interval (PI), excess significance bias, and the results of credibility ceiling sensitivity analyses.

Results: We included 41 meta-analyses containing 63 associations between PDAC survival outcomes and prognostic biomarkers. Although, none was supported by strong evidence among these associations, an association between C-reactive protein to albumin ratio (CAR) and PDAC overall survival (OS) and an association between neutrophil-lymphocyte ratio (NLR) and PDAC OS were supported by highly suggestive evidence. Otherwise, the association between lactate dehydrogenase (LDH) and PDAC OS was supported by suggestive evidence. The remaining 60 associations were supported by weak or not suggestive evidence.

Conclusion: Associations between CAR or NLR and PDAC OS were supported by highly suggestive evidence. And the association between LDH and PDAC OS was supported by suggestive evidence. Although the methodological quality of the included systematic reviews and meta-analyses which were evaluated by AMSTAR2.0 is generally poor, the identification of the relatively robust prognostic biomarkers of PDAC may guide better post-operative intervention and follow-up to prolong patients' survival.

• biomarkers
• pancreatic ductal adenocarcinoma
• prognosis
• survival
• umbrella review

The high prevalence of early-diabetes in patients with pancreatic cancer (PanC) implies that its recognition could help identify people at high risk of developing PanC. Candidate microRNAs (miRNAs) associated with recent diabetes were screened from our previous miRNA expression profiling on 10 pools of plasma from PanC patients and non-PanC controls, both including also subjects with early- and late-diabetes. The droplet digital PCR (ddPCR) was used to re-test candidate miRNAs in a new independent cohort of 69 subjects (40 PanC, 29 non-PanC) with early- (17 PanC, 13 non-PanC) or late-diabetes (23 PanC, 16 non-PanC), and in 100 non-diabetic healthy subjects (HS). miRNA levels were evaluated for differences between subjects enrolled into the study and for their diagnostic performance, also compared to the CA 19-9 determinations. MiR-20b-5p, miR-29a, and miR-18a-5p were selected from the previous miRNA expression profiling. The ddPCR confirmed the increase of miR-20b-5p and miR-29a levels in PanC with early- compared to those with late-diabetes. Conversely, miR-20b-5p, miR-29a, and miR-18a-5p were over-expressed in both PanC and non-PanC with recent diabetes compared to HS, and each miRNA achieved a similar diagnostic performance in distinguishing either PanC or non-PanC with early-diabetes from HS (miR-20b-5p: AUC = 0.877 vs. AUC = 0.873; miR-29a: AUC = 0.838 vs. AUC = 0.810; miR-18a-5p: AUC = 0.824 vs. AUC = 0.875). Despite miR-20b-5p and miR-29a expressions were also higher both in PanC and non-PanC with late-diabetes with respect to HS, the diagnostic accuracy in PanC with late-diabetes vs. HS reached by each miRNA (miR-20b-5p: AUC = 0.760; miR-29a: AUC = 0.630) was lower than the ones achieved in PanC with early-diabetes vs. HS. Furthermore, miR-20b-5p achieved a higher diagnostic accuracy to discriminate non-PanC with early-diabetes from HS (AUC = 0.868; SP = 81%; PPV = 32.1%) compared to the CA 19-9 (AUC = 0.700; SP = 40.0%; PPV = 15.5%), and the joint (miR-20b-5p and CA 19-9) discrimination ability was higher than the one achieved by the CA 19-9 tested alone (AUC = 0.900, p = 0.003). Our data highlighted the association between miR-18a-5p and early-diabetes, and suggested for miR-20b-5p and miR-29 a role in identifying early diabetes in PanC, albeit not as an early manifestation of cancer. MiR-20b-5p as more informative marker than CA 19-9 in distinguishing non-PanC with recent diabetes from HS was also uncovered.

• circulating microRNA
• diagnostic performance
• early diabetes
• expression profile
• pancreatic cancer

• CA 19-9
• Chemotherapy
• Pancreatic cancer
• Response rate
• Tumor growth

Colorectal cancer (CRC) has high morbidity and mortality rates. Invasive techniques and other laboratory tests with variable sensitivity and specificity are currently used in diagnosis. Micro ribonucleic acids (miRNAs) have bio vital roles in cell proliferation and apoptosis. Dys-regulation of miRNAs is linked to tumour genesis. The objective of this study was to evaluate the specificity and sensitivity of serum non-invasive biomarkers (micro-RNAs), miR-1246, miR-23a, and miR-451in CRC patients.

Peripheral expression of three miRNAs (miR-1246, miR-23a and miR-451) was investigated in sera of 37 CRC Egyptian patients and 30 healthy controls, using quantitative real-time polymerase chain reaction trying to reach the optimal non-invasive combination of miRNAs.

Serum miR-1246 was up-regulated in sera of CRC patients compared to normal controls (fold change = 3.55; P<0.001) and showed 100% sensitivity and 80% specificity in diagnosis of CRC. Serum miR-451 was significantly down-regulated in CRC patients (fold change = -4.86; p= 0.014), whereas, miR-23a was down-regulated but this was not statistically significant.

Up-regulation of miR-1246 and down-regulation of miR-451 in the sera of primary CRC Egyptian patients were confirmed with high sensitivity and specificity. Large-scale studies on a wider spectrum of miRNAs in Egyptian CRC patients are needed.

• miR-1246
• miR-23a
• miR-451

Gram-negative bacteria mediated gemcitabine resistance in pre-clinical models. We determined if intratumoural lipopolysaccharide (LPS) detection by immunohistochemistry is associated with outcome in advanced pancreatic ductal adenocarcinoma (PDAC) treated with gemcitabine and non-gemcitabine containing 1st-line chemotherapy.

We examined LPS on tumour tissue from 130 patients treated within the randomised AIO-PK0104 trial and a validation cohort (n = 113) and analysed the association of LPS detection to patient outcome according to treatment subgroups.

In 24% of samples from the AIO-PK0104 study LPS was detected; in LPS-positive patients median OS was 4.4 months, compared to 7.3 months with LPS negative tumours (HR 1.732, p = 0.010). A difference in OS was detected in 1st-line gemcitabine-treated patients (n = 71; HR 2.377, p = 0.002), but not in the non-gemcitabine treatment subgroup (n = 59; HR 1.275, p = 0.478). Within the validation cohort, the LPS positivity rate was 23%, and LPS detection was correlated with impaired OS in the gemcitabine subgroup (n = 94; HR 1.993, p = 0.008) whereas no difference in OS was observed in the non-gemcitabine subgroup (n = 19; HR 2.596, p = 0.219).

The detection of intratumoural LPS as surrogate marker for gram-negative bacterial colonisation may serve as a negative predictor for gemcitabine efficacy in advanced PDAC.

The Clinical trial registry identifier is NCT00440167.

• basal cell carcinoma
• cancer
• carbohydrate 19-9 antigen
• multiple tumours
• nonmelanoma skin cancer
• occult primary malignancies
• squamous cell carcinoma

• Adult
• Aged
• Antineoplastic Agents/therapeutic use
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Biomarkers, Tumor/blood
• Carcinoma, Pancreatic Ductal/blood
• Carcinoma, Pancreatic Ductal/drug therapy
• Carcinoma, Pancreatic Ductal/mortality
• Down-Regulation
• Female
• Fluorouracil/therapeutic use
• Humans
• Immunohistochemistry
• Irinotecan/therapeutic use
• Leucovorin/therapeutic use
• Male
• MicroRNAs/blood
• MicroRNAs/genetics
• Middle Aged
• Netherlands/epidemiology
• Oxaliplatin/therapeutic use
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/drug therapy
• Pancreatic Neoplasms/mortality
• Survival Rate/trends

Although carbohydrate antigen 19-9 (CA 19-9) may be elevated in benign diseases, elevated CA 19-9 may cause a fear of cancer and unnecessary follow-up studies. Research on how to approach systematically in this case is very limited. The purpose of this study was to analyze the clinical features and the causes of CA 19-9 elevation without evidence of malignant or pancreatobiliary diseases. We retrospectively reviewed the medical records of patients who had CA 19-9 elevation (≥80 U/mL) and were found to be unrelated to cancer after follow-up. After exclusion, 192 patients were included in this study. The median level of CA 19-9 was 136.5 U/mL. The causes of CA 19-9 elevation were determined in 147 (76.6%) patients, and that was unknown in 45 (23.4%). The estimated causative diseases were hepatic diseases in 63 patients, pulmonary diseases in 32, gynecologic diseases in 38, endocrine diseases in 13, and spleen disease in 1. Of 45 patients with unknown cause, 35 had normalization of CA 19-9 and 10 had persistently elevated CA 19-9. In conclusion, CA 19-9 elevation without malignancies or pancreatobiliary diseases should be systematically evaluated and followed up. We suggest an algorithm to investigate the causes and follow up these patients.

• 18F-FDG PET/CT
• CA19-9
• Lymph nodal micrometastases
• Pancreatic cancer

• glycemic load
• cancer prevention
• fat mass
• dietary intervention
• proteomics

• Adipose Tissue/metabolism
• Adipose Tissue/pathology
• Adiposity/physiology
• Adolescent
• Adult
• Blood Chemical Analysis
• Blood Proteins/analysis
• Blood Proteins/metabolism
• Cross-Over Studies
• Diet
• Feeding Behavior/physiology
• Female
• Glycemic Load/physiology
• Humans
• Male
• Middle Aged
• Neoplasms/etiology
• Neoplasms/metabolism
• Organ Size
• Proteome/analysis
• Proteome/metabolism
• Proteomics/methods
• Signal Transduction/physiology
• Young Adult

• P30 CA015704 NCI NIH HHS
• R01 CA192222 NCI NIH HHS
• U54 CA116847 NCI NIH HHS

• Prognosis
• metastatic sites
• pancreatic cancer
• peritoneal carcinomatosis

• Nab-paclitaxel
• carbohydrate antigen 19.9
• gemcitabine
• neutrophil-to-lymphocyte ratio
• prognostic factor

• Follow-up
• Pancreatectomy
• Pancreatic cancer
• Postoperative surveillance
• Recurrence
• Systematic review

The prognostic role of serum LDH, CA19-9, CRP and ALB in PDAC patients are controversial. In contrast to single factor, there is much less information about the prognostic value of the combination of the four factors in locally advanced and metastatic PDAC patients. It's essential to set up a survival model with the combination of tumor metabolism, tumor biomarker, systemic inflammation and nutritional status to eliminate the prognostic inaccuracy in single biomarker. 94 advanced PDAC patients who received palliative chemotherapy from 2009 to 2017 were recruited for this study. The predictive value of pretreatment serum LDH, CA19-9, CRP and ALB levels for OS were evaluated, and the same as combination of the four factors. It was confirmed that serum LDH, CA19-9, CRP and ALB levels were independent prognostic factors for OS by multivariate analyses. The results of Kaplan-Meier analyses revealed that serum LDH, CA19-9, CRP, ALB levels as well as the combination of the four factors were correlated with OS. It's concluded that the combination of the pretreatment serum LDH, CA19-9, CRP and ALB levels is a prognostic factor for advanced PDAC patients.

• Albumin
• C-reactive protein
• CA-19-9 Antigen
• Lactate Dehydrogenase
• Pancreatic cancer
• Prognosis

To evaluate the relationship between serum CA19-9 and overall survival in patients with advanced pancreatic cancer.

109 advanced pancreatic cancer patients with gemcitabine based first-line chemotherapy were included. The effect of pretreatment CA19-9 level on overall survival was modeled by Cox proportional hazard regression. The effect of CA19-9 kinetics on overall survival was modeled by an extended Cox regression with a time varying coefficient and a time varying covariate.

Univariate analysis indicated that baseline CA19-9 correlated with OS (HR = 1.66, p < 0.01) and this association remained significant within multivariate analysis (HR = 1.56, P < 0.01). For the analysis of CA19-9 kinetics, the extended Cox model showed that the effect of CA19-9 on overall survival changed with time: increased in the first two months and reached the top at a HR of about 2, then decreased for the next two months to a HR of about 1.56 and finally tended to be stable. The combination of pretreatment CA19-9 and CA19-9 at 2 month may better evaluate the patients’ prognosis compared to pretreatment CA19-9 alone.

Pretreatment CA19-9 and CA19-9 kinetics may serve as a useful serum biomarker in advanced pancreatic cancer.

• CA19-9
• biomarker
• pancreatic cancer
• prognosis
• varying coefficient model

• CA199
• acute pancreatitis
• pancreatic cancer
• retrospective study

• ca19-9
• metastatic pancreatic cancer
• neutrophil-to-lymphocyte ratio
• prognostic factor

• Aged
• Area Under Curve
• Biomarkers, Tumor/blood
• CA-19-9 Antigen/blood
• Female
• Humans
• Kaplan-Meier Estimate
• Leukocyte Count
• Lymphocyte Count
• Lymphocytes
• Male
• Middle Aged
• Multivariate Analysis
• Neutrophils
• Pancreatic Neoplasms/blood
• Pancreatic Neoplasms/mortality
• Prognosis
• Proportional Hazards Models
• Regression Analysis
• Retrospective Studies

• CA19-9 elevation
• benign
• bronchogenic cyst

• Adenocarcinoma/classification
• Adenocarcinoma/mortality
• Adenocarcinoma/pathology
• Adenocarcinoma/surgery
• Adult
• Aged
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Pancreatectomy
• Pancreatic Neoplasms/classification
• Pancreatic Neoplasms/mortality
• Pancreatic Neoplasms/pathology
• Pancreatic Neoplasms/surgery
• Prognosis
• ROC Curve
• Retrospective Studies
• Tumor Burden