title: Serum apolipoprotein C-II is prognostic for survival after pancreatic resection for adenocarcinoma.
abstract: BACKGROUND
  Pancreaticoduodenectomy remains a major undertaking. A preoperative blood test, which could confidently predict the benefits of surgery would improve the selection of pancreatic cancer patients for surgery. This study aimed to identify protein biomarkers prognostic for long-term survival and to validate them with clinico-pathological information.
  
  
  METHODS
  Serum from 40 preoperative patients was used to train for predictive biomarkers using surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI), and the results were verified on 21 independent samples. Two predictive proteins were identified by tryptic peptide mass fingerprinting and sequencing, and validated on serum from another 57 patients by enzyme-linked immunosorbent assay (ELISA). The influence of these proteins on growth and invasion of two cancer cell lines was tested in-vitro.
  
  
  RESULTS
  The SELDI panel of m/z 3700, 8222 and 11 522 peaks predicted <12 months' survival (ROC AUC: 0.79, 0.64-0.90; P<0.039). When CA19-9 was added, the ROC AUC increased to 0.95 (0.84-0.99; P<0.0001). The six subjects in the verification group who died within 12 months were correctly classified. The m/z 8222 and 11 522 proteins were identified as Serum ApoC-II and SAA-1, respectively. In the validation samples, ELISA results confirmed that ApoC-II was predictive of survival (Kaplan-Meier P<0.009), but not SAA-I. ApoC-II, CA19-9 and major-vessel involvement independently predicted survival. ApoC-II and SAA-1 increased cell growth and invasion of both cancer cell lines.
  
  
  CONCLUSIONS
  Serum ApoC-II, CA19-9 and major-vessel invasion independently predict survival and improves selection of patients for pancreaticoduodenectomy.
authors.affiliation: Department of Gastrointestinal Surgery, University of Sydney, Kolling Institute of Medical Research, St Leonards NSW 2065, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Xue
authors.forename: J W
authors.initials: JW
authors.lastname: Chang
authors.forename: L
authors.initials: L
authors.lastname: Chung
authors.forename: J
authors.initials: J
authors.lastname: Samra
authors.forename: T
authors.initials: T
authors.lastname: Hugh
authors.forename: A
authors.initials: A
authors.lastname: Gill
authors.forename: G
authors.initials: G
authors.lastname: Butturini
authors.forename: R C
authors.initials: RC
authors.lastname: Baxter
authors.forename: R C
authors.initials: RC
authors.lastname: Smith
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D053304:Apolipoprotein C-II / Q000097:blood*; D015153:Blotting, Western; D045744:Cell Line, Tumor; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000401:mortality / Q000601:surgery; D011379:Prognosis; D016016:Proportional Hazards Models; D000685:Serum Amyloid A Protein / Q000032:analysis; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
chemical_list: D053304:Apolipoprotein C-II; C521404:SAA1 protein, human; D000685:Serum Amyloid A Protein