Copyright of Informa UK Ltd. Printing and distribution strictly prohibited Review 10.1517/14728222.11.12.1553 © 2007 Informa UK Ltd ISSN 1472-8222 1553 1. Introduction 2. Materials and methods 3. Expert opinion Oncologic, Endocrine & Metabolic Molecular prognostic factors in patients with pancreatic cancer Giuseppe Tonini † , Francesco Pantano, Bruno Vincenzi, Armando Gabbrielli, Roberto Coppola & Daniele Santini † University Campus Bio-Medico of Rome, Medical Oncology, Via Emilio Longoni, 83, 00155, Rome, Italy Pancreatic cancer is the fourth most common cause of cancer death in Western society and is a leading cause of cancer death worldwide. Its incidence and mortality rates are almost identical. Surgery is the only treatment theorically curative, but < 20% of all patients admitted with ductal adenocarcinoma of the pancreas undergo resection and at best, 25% of those survive for 5 years. The identification of prognostic factors that are able to stratify patient populations recognizing those that could able to benefit by a radical surgical treatment and/or a chemotherapeutic treatment. This paper is a not only a detailed review of existing studies evaluating pancreatic cancer biomarkers, but also a critical evaluation of the real clinical use of these kinds of prognostic factors with the purpose to help discriminate between a variety of factors which, so far, can be con- sidered really useful in everyday clinical practice. Although no single marker has been shown to be perfect in predicting patient outcome, a profile based on the best of these markers may prove useful in directing patient therapy. The markers with the strongest evidence as independent predictors of patient outcome include, p16, MMP7 and vascular endothelial growth factor. Keywords: genes, outcome, pancreatic cancer, prognosis, protein, survival Expert Opin. Ther. Targets (2007) 11(12):1553-1569 1. Introduction Pancreatic cancer is the fourth most common cause of cancer death in Western society and is a leading cause of cancer death worldwide. Its incidence and mortality rates are almost identical. The 5-year survival rate is ∼ 5%, and the median survival time is 3 – 6 months. Surgery is the only treatment theorically curative but < 20% of all patients admitted with ductal adenocarcinoma of the pancreas undergo resection, and at best 25% of those survive for 5 years [1-3]. Furthermore, the majority of patients who undergo resection die because of early liver metastasis. Thus, pancreatic ductal adenocarcinoma is one of the most malignant and aggressive cancers and predicting prognosis for patients with pan- creatic cancers may identify those who could benefit from aggressive intervention including surgery and/or chemotherapy. Beside the classical clinical–pathologic factors it was necessary to look for new type of biologic prognostic factors. The molecular biology of pancreatic cancer and its progression is characterized by aberrant activity of several regulatory pathways, both within the pancreas cells and in the surrounding tissue. Variations at the DNA, RNA and/or protein levels of molecules involved in these pathways are all potential candidate markers of prognosis. Finally, the study of molecular markers in pancreatic cancer can be important not only because of potential relationships with outcome but also because the association of a molecule with adverse outcome might suggest a key