Elevated serum lipoprotein(a) as a prognostic marker for reduced survival in pancreatic cancer.

[BACKGROUND] This study aimed to assess the prognostic significance of serum lipoprotein(a) [Lp(a)] levels regarding overall survival (OS) and progression-free survival (PFS) among patients diagnosed with pancreatic cancer (PC).

[METHODS] A retrospective cohort of 364 pathologically confirmed PC patients treated at the Affiliated Hospital of Qingdao University between January 2019 and December 2022 was analyzed. The optimal cutoff for Lp(a) was identified using X-tile software, allowing categorization into high and low Lp(a) groups. To minimize selection bias, propensity score matching (PSM) was utilized. Survival outcomes were compared using Kaplan-Meier curves and log-rank tests. Cox proportional hazards models were applied to identify independent prognostic variables affecting OS and PFS.

[RESULTS] Patients with high Lp(a) had significantly shorter OS and PFS both before and after PSM (post-PSM OS: 12.28 vs. 27.67 months, P = 0.003; PFS: 7.00 vs. 11.30 months, P = 0.002). Multivariate Cox analysis confirmed high Lp(a) as an independent predictor of poor OS [HR = 2.11 (1.17-3.81), P = 0.013] and PFS [HR = 2.14 (1.20-3.83), P = 0.010]. In the surgical subgroup (n = 215), high Lp(a) was also associated with worse OS (16.43 vs. 35.47 months, P = 0.02) and PFS (8.40 vs. 11.77 months, P = 0.036). Multivariate analysis in this subgroup showed that high Lp(a) remained an independent risk factor for OS [HR = 2.82 (1.36-5.87), P = 0.006] and PFS [HR = 2.01 (1.06-3.86), P = 0.034].

[CONCLUSION] Elevated serum Lp(a) is an independent predictor of reduced OS and PFS in patients with pancreatic cancer. In contrast to conventional lipid profiles, the genetic stability of Lp(a) makes it a reliable baseline prognostic marker.