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

Background: The relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown. Aim: To investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer. Methods: 194 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 mu g/g), severely reduced (faecal elastase-1 <100 and >20 mu g/g) and extremely reduced (faecal elastase-1 <= 20 mu g/g). Results: Median faecal elastase-1 was 204 mu g/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 mu g/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 mu g/g (Hazard ratio 1.59 P=0.023) resulted as independent predictors of survival in advanced pancreatic cancer patients. Conclusions: A low value of faecal elastase-1 is strongly correlated with a poor survival in advanced pancreatic cancer. (C) 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.