Journal article
It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors
Annals of surgical oncology, Vol.28(2), pp.732-741
02/2021
DOI: 10.1245/s10434-020-08784-0
PMCID: PMC7855034
PMID: 32656719
Abstract
Tumor biomarkers (TBMs) reflect disease burden and correlate with survival for small bowel neuroendocrine tumors (SBNETs). This study sought to determine the performance of chromogranin A (CgA), pancreastatin (PST), neurokinin A (NKA), and serotonin (5HT) during follow-up assessment of resected SBNETs.
An institutional database identified patients undergoing surgery for SBNETs. Tumor biomarker levels were assessed as categorical (normal vs elevated) and continuous variables for association with progression-free survival (PFS) and overall survival (OS) via the Kaplan-Meier method with Cox multivariable models adjusted for confounders. Sensitivity, specificity, and predictive values of TBM levels in identifying imaging-confirmed progression were calculated.
In 218 patients (44% female, 92% node + , 73% metastatic, 97% G1 or G2), higher levels of CgA, PST, NKA, and 5HT correlated with higher-grade and metastatic disease at presentation (p < 0.05). Elevated pre- and postoperative CgA, PST, and NKA correlated with lower PFS and OS (p < 0.05; median follow-up period, 49.6 months). Normal CgA, PST, and NKA were present in respectively 20.3%, 16.9%, and 72.6% of the patients with progression, whereas elevated levels were present in respectively 69.5%, 24.8%, and 1.3% of the patients without progression. Using TBMs to determine progression showed superiority of PST (78.9% accuracy) over CgA (63.3% accuracy) or CgA and PST together (60.3% accuracy).
Although specific for progression, NKA was rarely elevated, limiting its usefulness. Pre- and postoperative PST and CgA correlated with disease burden and survival, with PST providing better discrimination of outcomes. During the follow-up period, use of PST most accurately detected progression. These results suggest that PST should replace CgA for SBNET surveillance.
Details
- Title: Subtitle
- It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors
- Creators
- Catherine G Tran - University of IowaScott K Sherman - University of IowaAaron T Scott - University of IowaPo Hien Ear - University of IowaChandrikha Chandrasekharan - University of IowaAndrew M Bellizzi - University of IowaJoseph S Dillon - University of IowaThomas M O'Dorisio - University of IowaJames R Howe - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Annals of surgical oncology, Vol.28(2), pp.732-741
- DOI
- 10.1245/s10434-020-08784-0
- PMID
- 32656719
- PMCID
- PMC7855034
- ISSN
- 1068-9265
- eISSN
- 1534-4681
- Grant note
- UL1 TR002537 / NCATS NIH HHS T32 CA078586 / NCI NIH HHS T32 CA148062 / NCI NIH HHS T32CA148062 / NCI NIH HHS T32CA078586 / NCI NIH HHS P50 CA174521-01 / NCI NIH HHS CTSA program grant UL1TR002537 / NIH HHS P30 CA086862 / NCI NIH HHS P50 CA174521 / NCI NIH HHS
- Language
- English
- Date published
- 02/2021
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Pathology; Surgery; Fraternal Order of Eagles Diabetes Research Center; Endocrinology and Metabolism; Internal Medicine
- Record Identifier
- 9984185281702771
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