Low serum level of cholinesterase at recurrence of pancreatic cancer is a poor prognostic factor and relates to systemic disorder and nerve plexus invasion.
OBJECTIVE
Systemic disorder is a characteristic of advanced pancreatic cancer. Clinical prognostic factors in earlier disease state than terminal stage are expected to be sensitive markers for the foresight of systemic disorder. This study aimed to find the associations between these sensitive markers and morphological factors of primary tumor that may indicate finding a way of pathogenesis of systemic disorder.


METHODS
The current study examined 75 patients who received macroscopic curative resection for pancreatic cancer in our institution as follows: (1) identification of clinical prognostic factors at initial recurrence after resection of primary tumor and (2) analysis of correlations between clinical prognostic factors and histological findings in primary tumor.


RESULTS
Important prognostic factors were peritoneal dissemination and serum levels of carbohydrate antigen 19-9 and cholinesterase. Only low levels of serum cholinesterase correlated to nerve plexus invasion in histological findings of primary tumor. Patients with low cholinesterase levels show systemic disorder, including poor performance status, anemia, and hypoalbuminemia.


CONCLUSIONS
Nerve invasion may thus result in low functional state of the liver followed by systemic disorder. This mechanism may be useful for elucidating cancer cachexia in future studies.
Mitsunaga
Shuichi
S
Department of Upper Abdominal Surgery, National Cancer Center Hospital East, Kashiwa, Japan.
Kinoshita
Taira
T
Hasebe
Takahiro
T
Nakagohri
Toshio
T
Konishi
Masaru
M
Takahashi
Shinichiro
S
Gotohda
Naoto
N
Ochiai
Atsushi
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000201:enzymology / Q000473:pathology / Q000601:surgery; D002802:Cholinesterases / Q000097:blood*; D017615:Enteric Nervous System / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000201:enzymology; D010190:Pancreatic Neoplasms / Q000201:enzymology* / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D012008:Recurrence
D002802:Cholinesterases