Elevation in multiple serum inflammatory biomarkers predicts survival of pancreatic cancer patients with inoperable disease.
OBJECTIVE
Cancer-associated inflammation plays a driver role in pancreatic tumor development and progression. Moreover, recent studies have implicated the inflammatory tumor microenvironment in modulating therapy response and inducing resistance. The aim of this study is to investigate the prognostic and predictive value of the inflammatory biomarkers serum ferritin and C-reactive protein (CRP) in advanced pancreatic cancer patients.


METHODS
We measured pretreatment serum ferritin and CRP levels in 159 patients with inoperable pancreatic cancer participating in a phase III trial.


RESULTS
Serum ferritin and CRP levels were examined for correlations with overall survival using Kaplan-Meier analysis. When analyzed on a categorical basis, patients with higher ferritin (>median) or CRP (>25th percentile) had shorter overall survival. Moreover, the two biomarkers were not correlated suggesting independent mechanisms of production and release. However, when patients were evaluated by their ferritin and CRP levels, only patients with elevation in both inflammatory biomarkers showed a significant decrease in overall survival.


CONCLUSIONS
Serum ferritin and CRP are independent prognostic factors for shorter survival in patients with inoperable pancreatic tumors. Moreover, the evaluation of patients based on both biomarkers suggested that their prognostic value, although independent, reflected the broader state of cancer-associated inflammation. Thus, serum ferritin and CRP should be further explored as clinical biomarkers.
Department of Neurosurgery, The Pennsylvania State University Hershey Medical Center, Hershey, PA, 17033, USA.
A
A
Alkhateeb
L
L
Zubritsky
B
B
Kinsman
K
K
Leitzel
C
C
Campbell-Baird
S M
SM
Ali
J
J
Connor
A
A
Lipton
D000230:Adenocarcinoma / Q000097:blood / Q000401:mortality* / Q000473:pathology; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D004311:Double-Blind Method; D005293:Ferritins / Q000097:blood*; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000175:diagnosis*; D009367:Neoplasm Staging; D015282:Octreotide / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000097:blood / Q000401:mortality* / Q000473:pathology; D011379:Prognosis; D015996:Survival Rate
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein; D005293:Ferritins; D015282:Octreotide; D005472:Fluorouracil