Faecal elastase-1 is an independent predictor of survival in advanced pancreatic cancer

Dig Liver Dis. 2012 Nov;44(11):945-51. doi: 10.1016/j.dld.2012.05.017. Epub 2012 Jun 28.


Background: The relationship between prognosis of advanced pancreatic cancer and exocrine secretion impairment is unknown.

Aim: To investigate a possible correlation between faecal elastase-1 value and survival in advanced pancreatic cancer.

Methods: 194 patients with advanced pancreatic cancer were prospectively enrolled between 2007 and 2009 and underwent faecal elastase-1 measurement. Exocrine pancreatic secretion was defined as "moderately reduced" (faecal elastase-1: 100-200 μg/g), "severely reduced" (faecal elastase-1<100 and >20 μg/g) and "extremely reduced" (faecal elastase-1≤20 μg/g).

Results: Median faecal elastase-1 was 204 μg/g (interquartile range 19; 489). Overall, 48 patients (25%) had an extremely reduced exocrine pancreatic secretion, 28 (14%) a severely reduced exocrine pancreatic secretion and 21 (11%) a moderately reduced exocrine pancreatic secretion. Patients with extremely reduced exocrine pancreatic secretion had higher rates of pancreatic head localizations (P<0.01) and of jaundice (P<0.01). Median overall survival was 10.5 months. Patients with faecal elastase-1≤20 μg/g had a worse prognosis (median survival: 7 versus 11 months, P=0.031). Presence of metastases (Hazard ratio 1.81, P<0.0001), haemoglobin ≤12 g/L (Hazard ratio 2.12, P=0.001), albumin ≤40 g/L (Hazard ratio 1.64, P=0.010) and FE-1≤20 μg/g (Hazard ratio 1.59 P=0.023) resulted as independent predictors of survival in advanced pancreatic cancer patients.

Conclusions: A low value of faecal elastase-1 is strongly correlated with a poor survival in advanced pancreatic cancer.

MeSH terms

  • Aged
  • Carcinoma, Pancreatic Ductal / complications
  • Carcinoma, Pancreatic Ductal / diagnosis*
  • Carrier Proteins* / analysis
  • Carrier Proteins* / metabolism
  • Exocrine Pancreatic Insufficiency / diagnosis
  • Exocrine Pancreatic Insufficiency / etiology
  • Feces / chemistry
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pancreas, Exocrine / metabolism*
  • Pancreas, Exocrine / physiopathology
  • Pancreatic Elastase
  • Pancreatic Neoplasms / complications
  • Pancreatic Neoplasms / diagnosis*
  • Prognosis
  • Proportional Hazards Models
  • Prospective Studies
  • Survival Rate


  • Carrier Proteins
  • Pancreatic Elastase
  • cholesterol-binding protein