Serum platelet factor 4 is an independent predictor of survival and venous thromboembolism in patients with pancreatic adenocarcinoma.
BACKGROUND
Improved diagnostic, predictive, and prognostic biomarkers for pancreatic ductal adenocarcinoma (PDAC) are urgently needed. Platelet factor 4 (PF4) has been proposed as a diagnostic biomarker for PDAC. We assessed the diagnostic and prognostic potential of serum PF4 levels in PDAC patients.


METHODS
Serum PF4 levels were determined by enzyme-linked immunosorbent assay in an initial cohort of 62 PDAC patients, 62 healthy control subjects, and 34 chronic pancreatitis patients. A second validation set consisted of 71 PDAC patients. Linear regression models were used to relate PF4 to class, gender, age, stage, platelet count, and diagnosis. Survival analyses were done using univariate and multivariate Cox models.


RESULTS
In the initial cohort, serum PF4 levels distinguished PDAC from chronic pancreatitis patients (P = 0.011), but not from healthy control subjects (P = 0.624). In PDAC patients, high serum PF4 level significantly predicted decreased survival independent of all covariates examined (P < 0.01). The prognostic relationship of serum PF4 levels remained significant in the validation set. Venous thromboembolism (VTE) occurred in 20% of the 133 PDAC patients. The VTE risk was higher in subjects with elevated PF4 levels (P = 0.009).


CONCLUSIONS
Serum PF4 is shown for the first time to be prognostic for survival in PDAC patients. High PF4 is associated with an increased risk for the development of VTE.


CONCLUSIONS
Serum PF4 levels may be useful for patient stratification and for directing treatment options in patients with pancreatic cancer including anticoagulation prophylaxis. The relationship between high PF4 levels and poorer outcomes requires further study.
Poruk
Katherine E
KE
Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.
Firpo
Matthew A
MA
Huerter
Luke M
LM
Scaife
Courtney L
CL
Emerson
Lyska L
LL
Boucher
Kenneth M
KM
Jones
Kimberly A
KA
Mulvihill
Sean J
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D021441:Carcinoma, Pancreatic Ductal / Q000097:blood* / Q000473:pathology; D016022:Case-Control Studies; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology; D050500:Pancreatitis, Chronic / Q000097:blood; D010978:Platelet Factor 4 / Q000097:blood*; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood*
D014408:Biomarkers, Tumor; D010978:Platelet Factor 4