Pancreatic cancer remains one of the deadliest malignancies, with limited improvements in long-term survival despite advances in surgery and systemic therapy. Prognostic markers that can reliably stratify patients at diagnosis are urgently needed to guide treatment decisions and inform clinical discussions. While conventional lipid profiles are routinely measured, their prognostic value in cancer has been inconsistent. In contrast, lipoprotein(a) [Lp(a)] is genetically determined and relatively stable over time, making it an attractive candidate biomarker.
A new retrospective study explored whether serum Lp(a) levels are associated with survival outcomes in patients with pancreatic cancer, examining both overall survival (OS) and progression-free survival (PFS).
High Lp(a) Linked to Shorter Survival
The study analysed data from 364 patients with pathologically confirmed pancreatic cancer treated at a single tertiary centre between 2019 and 2022. Using X-tile software, researchers identified an optimal cutoff to classify patients into high and low Lp(a) groups. To strengthen the robustness of the findings and reduce confounding, propensity score matching was applied before survival analyses.
Across the full cohort, patients with elevated Lp(a) levels experienced markedly worse outcomes. After matching, median overall survival was 12.28 months in the high Lp(a) group compared with 27.67 months in the low Lp(a) group. Progression-free survival followed a similar pattern, with median durations of 7.00 versus 11.30 months, respectively. These differences were statistically significant and consistent with pre-matching analyses.
Multivariate Cox regression confirmed that high Lp(a) was an independent predictor of poor prognosis. Patients with elevated levels had more than double the risk of death and disease progression compared with those with lower Lp(a), even after adjusting for other clinical factors.
Prognostic Value Persists After Surgery
Importantly, the prognostic impact of Lp(a) remained evident in patients who underwent surgical treatment. Among the 215 patients in this subgroup, those with high Lp(a) levels again demonstrated significantly worse outcomes. Median overall survival was 16.43 months in the high Lp(a) group compared with 35.47 months in the low Lp(a) group, alongside shorter progression-free survival.
Further multivariate analyses in the surgical cohort reinforced elevated Lp(a) as an independent risk factor for both overall and progression-free survival, underscoring its potential relevance even in patients receiving curative-intent treatment.
A Stable Biomarker with Clinical Potential
The authors highlight that, unlike traditional lipid measures, Lp(a) levels are largely genetically determined and remain relatively stable over a lifetime. This biological stability makes Lp(a) an attractive baseline biomarker for prognostic assessment in pancreatic cancer. While further prospective validation is needed, these findings suggest that serum Lp(a) could help identify high-risk patients and support more personalised management strategies in this challenging disease.
Reference
Liu J et al. Elevated serum lipoprotein(a) as a prognostic marker for reduced survival in pancreatic cancer. BMC Gastroenterol. 2025;DOI: 10.1186/s12876-025-04573-9.
