It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors

Catherine G Tran; Scott K Sherman; Aaron T Scott; Po Hien Ear; Chandrikha Chandrasekharan; Andrew M Bellizzi; Joseph S Dillon; Thomas M O'Dorisio; James R Howe

doi:10.1245/s10434-020-08784-0

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It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors

Journal article

Peer reviewed

It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors

Catherine G Tran, Scott K Sherman, Aaron T Scott, Po Hien Ear, Chandrikha Chandrasekharan, Andrew M Bellizzi, Joseph S Dillon, Thomas M O'Dorisio and James R Howe

Annals of surgical oncology, Vol.28(2), pp.732-741

02/2021

DOI: 10.1245/s10434-020-08784-0

PMCID: PMC7855034

PMID: 32656719

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https://www.ncbi.nlm.nih.gov/pmc/articles/7855034View

Open Access

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.

Biomarkers, Tumor

Chromogranin A

Female

Humans

Intestinal Neoplasms - surgery

Intestine, Small - surgery

Male

Neuroendocrine Tumors - surgery

Pancreatic Neoplasms

Stomach Neoplasms

Details

Title: Subtitle: It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors
Creators: Catherine G Tran - University of Iowa
Scott K Sherman - University of Iowa
Aaron T Scott - University of Iowa
Po Hien Ear - University of Iowa
Chandrikha Chandrasekharan - University of Iowa
Andrew M Bellizzi - University of Iowa
Joseph S Dillon - University of Iowa
Thomas M O'Dorisio - University of Iowa
James 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
NLM abbreviation: Ann Surg Oncol
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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