title: Elevated urinary levels of urokinase-type plasminogen activator receptor (uPAR) in pancreatic ductal adenocarcinoma identify a clinically high-risk group.
abstract: BACKGROUND
  The urokinase plasminogen activator receptor is highly expressed and its gene is amplified in about 50% of pancreatic ductal adenocarcinomas; this last feature is associated with worse prognosis. It is unknown whether the level of its soluble form (suPAR) in urine may be a diagnostic-prognostic marker in these patients.
  
  
  METHODS
  The urinary level of suPAR was measured in 146 patients, 94 pancreatic ductal adenocarcinoma and 52 chronic pancreatitis. Urine from 104 healthy subjects with similar age and gender distribution served as controls. suPAR levels were normalized with creatinine levels (suPAR/creatinine, ng/mg) to remove urine dilution effect.
  
  
  RESULTS
  Urinary suPAR/creatinine values of pancreatic ductal adenocarcinoma patients were significantly higher (median 9.8; 25th-75th percentiles 5.3-20.7) than those of either healthy donors (median 0; 0-0.5) or chronic pancreatitis patients (median 2.7; 0.9-4.7). The distribution of values among cancer patients was widespread and asymmetric, 53% subjects having values beyond the 95th percentile of healthy donors. The values of suPAR/creatinine did not correlate with tumour stage, Ca19-9 or CEA levels. Higher values correlated with poor prognosis among non-resected patients at univariate analysis; multivariate Cox regression identified high urinary suPAR/creatinine as an independent predictor of poor survival among all cancer patients (odds ratio 2.10, p = 0.0023), together with tumour stage (stage III odds ratio 2.65, p = 0.0017; stage IV odds ratio 4.61, p < 0.0001) and female gender (odds ratio 1.85, p = 0.01).
  
  
  CONCLUSIONS
  A high urinary suPAR/creatinine ratio represents a useful marker for the identification of a subset of patients with poorer outcome.
authors: Department of Pathology and Diagnostics, University of Verona, Italy.
authors: Claudio
authors: C
authors: Sorio
authors: Andrea
authors: A
authors: Mafficini
authors: Federico
authors: F
authors: Furlan
authors: Stefano
authors: S
authors: Barbi
authors: Antonio
authors: A
authors: Bonora
authors: Giorgio
authors: G
authors: Brocco
authors: Francesco
authors: F
authors: Blasi
authors: Giorgio
authors: G
authors: Talamini
authors: Claudio
authors: C
authors: Bassi
authors: Aldo
authors: A
authors: Scarpa
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000652:urine*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000652:urine*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000652:urine*; D050500:Pancreatitis, Chronic / Q000652:urine; D011379:Prognosis; D016016:Proportional Hazards Models; D055293:Receptors, Urokinase Plasminogen Activator / Q000378:metabolism*
chemical_list: D055293:Receptors, Urokinase Plasminogen Activator