New biomarkers help guide pancreatic cancer surgery

Surgery to remove pancreatic cancer is a risky business. Know as the Whipple procedure, or pancreaticoduodenectomy, it is a major operation involving the removal of half of the pancreas, which is wrapped around major blood vessels.

Around 3-5 per cent of patients die from complications of surgery, and another 20 per cent die within six months from early cancer recurrence.

Surgery also involves at least three months recovery time. So the stakes are high and deciding who will and who won’t benefit ahead of time is important.

Now researchers at the Garvan Institute of Medical Research have discovered two biomarkers that can indicate the likelihood of success of pancreatic cancer surgery.

The biomarkers are two proteins, S100A2 and S100A4, which is absent suggest an average post-operative survival of nearly three years. The presence of both proteins suggests a survival of less than one year.

Given the high risk and impact of pancreatic cancer surgery, there are many cases where it’s a borderline decision to undergo the surgery or not. Testing for the presence of these biomarkers can help inform that decision and give patients a better idea of their chances for recovery.

Professor Andrew Biankin, Dr David Chang and members of the Pancreatic Cancer Research Team from Sydney’s Garvan Institute of Medical Research presented their study at the 2011 ASCO Gastrointestinal Cancers Symposium, held 20-22 January in San Francisco.

They associated the expression of the biomarkers, along with tumour size, with survival in a cohort of 372 patients who had undergone pancreatic surgery.

Biankin and Chang are both pancreatic cancer surgeons who regularly advise patients whether or not to undergo surgery, a challenging task especially if patient fitness for surgery is borderline.

“We know that the operation benefits about 20 per cent of people particularly well, and obviously we would like to be able to predict who they are likely to be,” said Biankin. “At the moment, we make decisions about when to operate based on very indirect measures, such as CT scans, which aren’t really sensitive enough.

“This information will allow us to be more aggressive, even when a tumour is big, if it has a benign biology – that is, when neither biomarker is present. Conversely, if both biomarkers were present, you probably wouldn’t operate.”

“We need something to help us when we’re making a tiebreaker decision. Something to help us decide whether or not surgery is worth the risk. Ultimately, each patient has to decide ‘is this operation going to benefit me?’ and if it’s not, why put yourself through the operation?”