Onkológia 4/2025
HRV – neuro-tumoral interactions in pancreatic cancer
Pancreatic cancer (PC) remains one of the most aggressive malignancies, characterized by a dismal prognosis and limited therapeutic efficacy. A critical determinant of tumor invasiveness and treatment resistance is the dynamic interplay between the tumor microenvironment (TME) and the systemic macroenvironment. Emerging evidence highlights the role of the autonomic nervous system (ANS)— particularly the balance between sympathetic and parasympathetic branches—in modulating tumor biology. Heart rate variability (HRV) has emerged as a non-invasive and quantifiable biomarker of ANS activity. Reduced HRV is consistently associated with increased sympathetic drive, systemic inflammation, and poor clinical outcomes across various cancer types. In pancreatic cancer, HRV may serve as a surrogate marker of neuro-tumoral interactions, influencing TME remodeling, angiogenesis, immune suppression, and perineural invasion. Current evidence supports HRV as a promising prognostic biomarker and a potential indicator of quality of life in PC patients, with implications for future individualized therapeutic strategies.
Keywords: pancreatic cancer, neurotransmitters, autonomic nervous system, heart rate variability (HRV), perineural invasion, prognostic biomarkers
