Predictive Value of Chromogranin A and a Pre-Operative Risk Score to Predict Recurrence After Resection of Pancreatic Neuroendocrine Tumors.

Autor: Fisher AV; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA., Lopez-Aguiar AG; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA., Rendell VR; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA., Pokrzywa C; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA., Rocha FG; Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA., Kanji ZS; Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA., Poultsides GA; Department of Surgery, Stanford University Medical Center, Stanford, CA, USA., Makris EA; Department of Surgery, Stanford University Medical Center, Stanford, CA, USA., Dillhoff ME; Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA., Beal EW; Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA., Fields RC; Department of Surgery, Washington University School of Medicine, St Louis, MO, USA., Panni RZ; Department of Surgery, Washington University School of Medicine, St Louis, MO, USA., Idrees K; Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Smith PM; Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Cho CS; Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Beems MV; Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA., Maithel SK; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA., Winslow ER; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA., Abbott DE; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA., Weber SM; Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA. webers@surgery.wisc.edu.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2019 Apr; Vol. 23 (4), pp. 651-658. Date of Electronic Publication: 2019 Jan 18.
DOI: 10.1007/s11605-018-04080-1
Abstrakt: Intro: Chromogranin A (CgA) may be prognostic for patients with neuroendocrine tumors; however, the clinical utility of this test is unclear.
Methods: Patients undergoing resection for pancreatic neuroendocrine tumors (pNET) were selected from the eight institutions of the US Neuroendocrine Tumor Study Group database. Cox regression was used to identify pre-operative variables that predicted recurrence-free survival (RFS), and those with p < 0.1 were included in a risk score. The risk score was tested in a unique subset of the overall cohort.
Results: In the entire cohort of 287 patients, median follow-up time was 37 months, and 5-year RFS was 73%. Cox regression analysis identified four variables for inclusion in the risk score: CgA > 5x ULN (HR 4.3, p = 0.01), tumor grade 2/3 (HR 3.7, p = 0.01), resection for recurrent disease (HR 6.2, p < 0.01), and tumor size > 4 cm (HR 4.5, p = 0.1). Each variable was assigned 1 point. Risk-score testing in the unique validation cohort of 63 patients revealed a 95% negative predictive value for recurrence in patients with zero points.
Discussion: This simple pre-operative risk scoring system resulted in a high degree of specificity for identifying patients at low-risk for tumor recurrence. This test can be utilized pre-operatively to aid informed decision-making.
Databáze: MEDLINE
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