Readily available biomarkers predict poor survival in metastatic pancreatic cancer

Biomarkers. 2021 Jun;26(4):325-334. doi: 10.1080/1354750X.2021.1893814. Epub 2021 Mar 21.


Background: Identification of metastatic pancreatic cancer (mPC) patients with the worst prognosis could help to tailor therapy. We evaluated readily available biomarkers for the prediction of 90-day mortality in a nationwide cohort of mPC patients.

Methods: Patients with synchronous mPC were included from the Netherlands Cancer Registry (2015-2017). Baseline CA19-9, albumin, CRP, LDH, CRP/albumin ratio, and (modified) Glasgow Prognostic Score ((m)GPS composed of albumin and CRP) were evaluated. Multivariable logistic regression analyses were performed to identify predictors of 90-day mortality. Prognostic value per predictor was quantified by Nagelkerke's partial R2.

Results: Overall, 4248 patients were included. Median overall survival was 2.2 months and 90-day mortality was 59.4% (n = 1629). All biomarkers predicted 90-day mortality in univariable analysis, and remained statistically significant after adjustment for clinically relevant factors and all other biomarkers (all p < 0.001). The prognostic value of the biomarkers combined was similar to WHO performance status. Patients who received chemotherapy had better outcomes than those who did not, regardless of biomarker levels.

Conclusions: In mPC patients, albumin, CA19-9, CRP, LDH, CRP/albumin ratio, and (m)GPS are prognostic for poor survival. Biomarkers did not predict response to chemotherapy. These readily available biomarkers can be used to better inform patients and to stratify in clinical trials.

Keywords: GPS; Pancreatic cancer; population-based; prognosis; readily available biomarkers.

MeSH terms

  • Aged
  • Biomarkers, Tumor / analysis*
  • C-Reactive Protein / analysis*
  • CA-19-9 Antigen / analysis*
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • L-Lactate Dehydrogenase / analysis*
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Metastasis
  • Netherlands
  • Pancreatic Neoplasms / diagnosis
  • Pancreatic Neoplasms / drug therapy
  • Pancreatic Neoplasms / metabolism*
  • Predictive Value of Tests
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Sensitivity and Specificity
  • Serum Albumin / analysis*


  • Biomarkers, Tumor
  • CA-19-9 Antigen
  • Serum Albumin
  • C-Reactive Protein
  • L-Lactate Dehydrogenase