S2030 The Prevalence of Low Fecal Elastase Among Patients With Pancreatic Adenocarcinoma
Bibliographic record
Abstract
Introduction: Pancreatic adenocarcinoma (PDAC) accounts for approximately 3% of all cancers in the United States. PDAC is often diagnosed at an advanced stage, leading to poor prognosis and high mortality rates. About 1% of patients with diabetes mellitus (DM) aged >= 50 years will be diagnosed with PDAC within 3 years and this is believed to be due to exocrine dysfunction from PDAC. A low fecal elastase is associated with exocrine dysfunction of the pancreas. We hypothesize that a low fecal elastase, either alone or in combination with glycemic indices, could enrich the population at risk for PDAC, enabling earlier detection. Methods: We retrospectively analyzed the characteristics and outcomes of PDAC patients at all Mayo Clinic sites who had fecal elastase levels checked. The study population consisted of 66 PDAC patients, categorized based on their fecal elastase (FE) levels: < 200 μg/g (suggestive of EPI) and >200 μg/g. We assessed various demographic, clinical, and treatment-related variables. Continuous variables were expressed as means and standard deviations and compared with the independent sample Students' T-test. Categorical variables were expressed as percentages and compared using Chi-squared testing. Results: Among the 66 PDAC patients, 49 (74.2%) had fecal elastase < 200 μg/g while 17 (25.8%) had levels >200 μg/g. Mean age at diagnosis was 64.8 years, with females accounting for 51.5% of the study sample. About 91% of study participants were White. Mortality rate was 50.0%, with a mean survival of 3.2 years. Diabetes was present in 48.5% of patients, predominantly type 2 (90.0%). Mean hemoglobin A1C (HbA1C) and fasting blood glucose (FBG) were 8.0% and 161 mg/dl respectively. Pancreatic enzyme replacement therapy was used by 78.8% of patients. FE indications included diarrhea (59.1%), weight loss (31.8%), abdominal pain (9.1%), and bloating (1.5%). The mean FE was 151.8 μg/g. Imaging confirmed a cancer mass in 97.0% of patients, with tumor locations primarily in the head (53.0%), body (24.2%), and tail (13.7%) of the pancreas. The majority of patients were diagnosed at AJCC stage 4 (37.9%) or with metastatic disease (42.4%). Surgery was performed in 45.5% of patients, while 78.8% received chemotherapy, with or without radiation therapy. Conclusion: The prevalence of a low fecal elastase in PDAC patients is high and could serve as a biomarker for early detection. More research is needed to explore the interactions between fecal elastase and glycemic indices in patients with PDAC (Table 1). Table 1. - Fecal elastase testing in patients with pancreatic adenocarcinoma Total number of PDAC patients 66 Fecal elastase < 200 49 (74.2%) Fecal elastase >200 17 (25.8%) Age at diagnosis, mean (sd) 64.8 (10.9) years Fecal elastase collection date After PDAC diagnosis 60 (90.9%) Mean PDAC diagnosis to FE level 21.1 months Female 34 (51.5%) Race White 60 (90.9%) Asian 3 (4.6%) Hispanic 2 (3.0%) Black 1 (1.5%) Mortality 32 (50.0%) Survival, mean (sd) 3.2 (3.3) years Survival categories 2-year survival 37 (56.1%) 5-year survival 10 (15.2%) BMI, mean (sd) 24.9 (5.9) Diabetes 32 (48.5%) Type 2 27 (90.0%) Type 1 3 (10.0%) Hemoglobin A1C, mean (sd) 8.0% (2.4%) Fasting glucose, mean (sd) 161 (49.4) mg/dl Receiving diabetes treatment 29 (90.6%) Acute pancreatitis 14 (21.2%) Chronic pancreatitis 4 (6.2%) Family history of pancreatic cancer 5 (7.6%) Tobacco use Never 38 (57.6%) Former 23 (34.8%) Active 5 (7.6%) Alcohol use Never 40 (60.6%) Former 8 (12.1%) Active 18 (27.3%) Fecal elastase, mean (sd) 151.8 (161.8) μg/g Fecal elastase indications Bloating 1 (1.5%) Diarrhea 39 (59.1%) Weight loss 21 (31.8%) Abdominal pain 6 (9.1%) Pancreatic enzyme replacement 52 (78.8%) Pancreas imaging CT scan 49 (74.2%) MRCP 9 (13.6%) MRI abdomen 14 (21.2%) EUS 48 (72.7%) Imaging findings Cancer mass 64 (97.0%) Acute pancreatitis 3 (4.6%) Chronic pancreatitis 2 (3.0%) Pancreatic cyst 5 (7.6%) IPMN 7 (10.6%) Main PD dilation 19 (28.8%) Tumor location Head 35 (53.0%) Body 16 (24.2%) Tail 9 (13.7%) Uncinate process 5 (7.6%) Multiple locations 1 (1.5%) FNA/biopsy confirmed 61 (92.4%) AJCC Stage Stage 1 10 (15.2%) Stage 2 10 (15.2%) Stage 3 16 (24.2%) Stage 4 25 (37.9%) Unspecified 5 (7.5%) Clinical stage Early 17 (25.8%) Locally advanced 21 (31.8%) Metastatic 28 (42.4%) Surgery 30 (45.5%) Chemo +/- RT 52 (78.8%)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".