Tumor Biology

, Volume 36, Issue 4, pp 2631–2640 | Cite as

Assessing novel prognostic serum biomarkers in advanced pancreatic cancer: the role of CYFRA 21-1, serum amyloid A, haptoglobin, and 25-OH vitamin D3

  • Michael Haas
  • Christoph Kern
  • Stephan Kruger
  • Marlies Michl
  • Dominik P. Modest
  • Clemens Giessen
  • Christoph Schulz
  • Jobst C. von Einem
  • Steffen Ormanns
  • Rüdiger P. Laubender
  • Stefan Holdenrieder
  • Volker Heinemann
  • Stefan Boeck
Research Article


The present prospective single-center study investigated the prognostic role of novel serum biomarkers in advanced pancreatic cancer (PC). Patients (pts) with locally advanced or metastatic PC treated with first-line palliative chemotherapy were included. Among others, the serum markers CYFRA 21-1, haptoglobin, serum-amyloid A (SAA), and 25-OH vitamin D3 were determined at baseline and categorized by pre-defined cut-offs [median values (MV), upper limits of normal (ULN), lower limits of normal (LLN), or the natural logarithm (ln)] and correlated with overall survival (OS). Among the 59 pts included, pre-treatment CYFRA 21-1 levels showed a strong correlation with OS independent of the applied cut-off (MV 4.9 ng/ml—14.2 vs. 4.2 months, HR 0.18, p = 0.001; ULN 3.3 ng/ml—14.2 vs. 4.4 months, HR 0.28, p = 0.003; [ln] CYFRA 21-1—HR 0.77, p = 0.013). Lower values of haptoglobin were additionally associated with an improvement in OS (categorized by LLN of 2.05 g/l—10.4 vs. 5.5 months, HR 0.46, p = 0.023; [ln] haptoglobin—HR 0.51, p = 0.036). Pts with baseline SAA values below the MV of 22 mg/l also had a prolonged OS (10.4 vs. 5.0 months, HR 0.47, p = 0.036). For 25-OH vitamin D3 levels, no significant correlation with OS was found. In multivariate analyses, pre-treatment CYFRA 21-1 levels (categorized by MV—HR 0.15, p = 0.032) as well as [ln] haptoglobin (HR 0.30, p = 0.006) retained their independent prognostic significance for OS. CYFRA 21-1, haptoglobin, and SAA might provide useful prognostic information in advanced PC. An external multicenter validation of these results is necessary.


CYFRA 21-1 Pancreatic cancer Prognostic marker Chemotherapy 



This work is part of the doctoral thesis of Christoph Kern.

Conflicts of interest

Michael Haas: Roche, Celgene, Boehringer Ingelheim (financial support for attending symposia)

Christoph Kern: None

Stephan Kruger: None

Marlies Michl: None

Dominik P. Modest: Roche, Amgen, Bayer, MerckSerono (honoraria for speaking at symposia); Roche, MerckSerono, Amgen (research grants); Merck, Amgen, Roche, Sanofi-Aventis (financial support for attending symposia); Amgen (position on advisory board)

Clemens Giessen: None

Christoph Schulz: None

Jobst C. von Einem: Apceth GmbH (financial support for attending symposia)

Steffen Ormanns: Novartis (honoraria for speaking at symposia, financial support for attending symposia)

Rüdiger P. Laubender: None

Stefan Holdenrieder: None

Volker Heinemann: Roche, Celgene (honoraria for speaking at symposia); Roche, Celgene (financial support for attending symposia); Roche, Celgene, Boehringer Ingelheim (research grants); Boehringer Ingelheim (position on advisory board)

Stefan Boeck: None


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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2014

Authors and Affiliations

  • Michael Haas
    • 1
  • Christoph Kern
    • 1
  • Stephan Kruger
    • 1
  • Marlies Michl
    • 1
  • Dominik P. Modest
    • 1
  • Clemens Giessen
    • 1
  • Christoph Schulz
    • 1
  • Jobst C. von Einem
    • 1
  • Steffen Ormanns
    • 2
  • Rüdiger P. Laubender
    • 3
  • Stefan Holdenrieder
    • 4
  • Volker Heinemann
    • 1
  • Stefan Boeck
    • 1
  1. 1.Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum GrosshadernLudwig-Maximilians-University of MunichMunichGermany
  2. 2.Department of PathologyLudwig-Maximilians-University of MunichMunichGermany
  3. 3.Institute of Medical Informatics, Biometry and EpidemiologyLudwig-Maximilians-University of MunichMunichGermany
  4. 4.Institute of Clinical Chemistry and Clinical PharmacologyUniversity Hospital BonnBonnGermany

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