Readily available biomarkers predict poor survival in metastatic pancreatic cancer

Marin Strijker*, Eran van Veldhuisen, Lydia G. van der Geest, Olivier R. Busch, Maarten F. Bijlsma, Nadia Haj Mohammad, Marjolein Y. Homs, Jeanin E. van Hooft, Joanne Verheij, Judith de Vos-Geelen, Johanna W. Wilmink, W. Ewout W. Steyerberg, Marc G. Besselink, Hanneke W. van Laarhoven*, Dutch Pancreatic Canc Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review



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.


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 R-2.


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.


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.

Original languageEnglish
Pages (from-to)325-334
Number of pages10
Issue number4
Publication statusPublished - 19 May 2021


  • Pancreatic cancer
  • prognosis
  • readily available biomarkers
  • GPS
  • population-based

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