Predictive factors in pancreatic ductal adenocarcinoma: Role of the inflammatory response

Objective. Pancreatic ductal adenocarcinoma is a highly lethal disease and most patients are not eligible for curable resection. Estimation of prognosis is essential in order to provide the best individual treatment for patients with pancreatic adenocarcinoma. Prediction of survival by current methods is limited, therefore the objective of this study was to determine possible prognostic factors identified at the time of diagnosis. Material and methods. All 119 consecutive patients with pancreatic ductal adenocarcinoma receiving palliative treatment at the Department of Surgery, Lund University Hospital from 1999 through 2002 were reviewed retrospectively. Prognostic factors and interventions were analysed statistically. C- reactive protein ( CRP) at the time of diagnosis was measured in 109 patients. Results. The overall median survival was 4.4 months. By means of a multivariate analysis it was shown that CRP ( p < 0.001) and tumour size ( p < 0.018) were independent predictors of survival. The median survival of patients with normal CRP at the time of diagnosis was 10.8 months versus 4.2 months for those with raised CRP levels (>= 5 mg/l; p < 0.001). Chemotherapy was the only intervention associated with a longer survival time ( p < 0.001 versus no chemotherapy). Conclusions. The poor prognosis for patients with pancreatic ductal adenocarcinoma was confirmed. CRP proved to be a strong independent predictor of survival. Together with previous reported factors, CRP could serve as a potential tool to determine future treatment strategies for optimal individual palliation.