Role of Fecal Elastase 1 in Pancreatic Cancer: A Pilot Study
Cavestro GM, Nouvenne A, Merli R, Comparato G, Leandro G, Corrente V, Dalla Valle R, Soliani P, Sianesi M, Franzè A, Di Mario F
Chair of Gastroenterology, Department of Clinical Sciences, University of Parma. Parma, Italy. Unit of Gastroenterology. Castellana Grotte (BA), Italy. Unit of Gastroenterology and Digestive Endoscopy. Parma, Italy. Surgical and Transplantation Clinic, Department of Surgical Sciences, University of Parma. Parma, Italy
Background Fecal elastase 1 (E1) is an indirect test of pancreatic function. Few study investigated the role of E1 in pancreatic cancer.
Aims 1) To evaluate fecal elastase levels in normal healthy subject in comparison to patients with pancreatic cancer; 2) to assess the relationship between fecal elastase 1 and tumor topography in patients with pancreatic cancer.
Methods Twenty-six consecutive patients (15 male, 11 female, mean age 72±21 years) admitted in our GI unit between January 2003 and February 2004 with first diagnosis of pancreatic cancer were enrolled in the study. Clinical, laboratory, histologic and imaging data were prospectively collected. Cancer topography was as follow: 14 patients had head cancer; 5 patients had body-tail cancer; 7 patients had head-body cancer. The head-body group of patients was removed from the study when we analyzed the relationship between fecal elastase levels and pancreatic cancer topography. Control group was composed of 165 normal healthy subject (70 male, 95 female, mean age 68±27 years). All patients and controls gave their informed consent. Stool elastase level was measured by an immunoenzymatic method (Meridian Bioscience Europe). According to our normal control group, we considered abnormal E1 values lower than 200 μg/g. Mann-Whitney rank-sum test was used fot data analysis.
Results Fecal elastase 1 levels were significantly decreased in pancreatic cancer patients (276.2±234.4) in comparison to normal subjects (504.5±145.3) (P<0.0001). A correlation between E1 levels and cancer topography was found: patients with pancreatic head cancer showed lower E1 levels (189.4±180.7) in comparison to patients with pancreatic body-tail cancer (421.2±229.1) but did not achieve significant level (P=0.078) because of low power of the test.
Conclusions Fecal elastase 1 is significantly decreased in patients with pancreatic cancer in comparison to normal healthy subject. Moreover, fecal elastase 1 could have a significant correlation with pancreatic cancer localization.
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