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Preoperative serum chromogranin-a is predictive of survival in locoregional jejuno-ileal small bowel neuroendocrine tumors
Journal article   Peer reviewed

Preoperative serum chromogranin-a is predictive of survival in locoregional jejuno-ileal small bowel neuroendocrine tumors

Praveen D Chatani, John G Aversa, James D McDonald, Tahsin M Khan, Xavier M Keutgen and Naris Nilubol
Surgery, Vol.170(1), pp.106-113
07/01/2021
DOI: 10.1016/j.surg.2021.01.048
PMCID: PMC8217103
PMID: 33814188

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Abstract

Small bowel neuroendocrine tumors (SB-NET) frequently metastasize to regional lymphatic or distant sites. Although most prognostication of SB-NET focuses on lymph node involvement, findings from studies of neuroendocrine tumors from other primary sites have suggested that preoperative serum chromogranin-A (CgA) levels may provide a more accurate metric. Using the National Cancer Database (2004-2016), we analyzed patients with locoregional SB-NET who underwent curative resection including an adequate lymphadenectomy (n = 1,274). A statistically optimized cut-point was used to dichotomize CgA cohort based on preoperative serum CgA levels. We determined that a CgA ≥139 ng/mL identified patients with significantly shorter estimated mean overall survival (6.6 years vs 7.6 years, log-rank P = .00001). These patients were also older (63 vs 57 years, P < .001) and had higher rates of poorly differentiated tumors (2.1% vs 0.7%, P = .04) or primary tumors >1 cm (88.2% vs 79.2%, P = .001). Clinical features associated with shorter overall survival included preoperative CgA ≥139 ng/mL (HR = 2.19, 95% CI 1.22-3.92; P = .009), age at diagnosis (HR = 1.06, 95% CI 1.03-1.09; P < .001), Charlson-Deyo score ≥2 (HR = 3.93, 95% CI 1.71-9.01; P = .001), and poorly differentiated tumors (HR = 11.22, 95% CI 4.16-30.24; P < .001). Neither lymph node metastasis nor T-stage were independently associated with shorter overall survival in patients with locoregional SB-NET. Elevated preoperative serum CgA is an adverse prognostic marker associated with shorter overall survival in patients with locoregional SB-NET.
 Adolescent Adult Aged Aged, 80 and over Chromogranin A - blood Databases, Factual Female Humans Ileal Neoplasms - blood Ileal Neoplasms - mortality Ileal Neoplasms - surgery Jejunal Neoplasms - blood Jejunal Neoplasms - mortality Jejunal Neoplasms - surgery Kaplan-Meier Estimate Lymph Node Excision Male Middle Aged Neuroendocrine Tumors - blood Neuroendocrine Tumors - mortality Neuroendocrine Tumors - surgery Predictive Value of Tests Preoperative Period Prognosis Young Adult

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