TY - JOUR
T1 - Predictive Value of Chromogranin A and a Pre-Operative Risk Score to Predict Recurrence After Resection of Pancreatic Neuroendocrine Tumors
AU - Fisher, Alexander V.
AU - Lopez-Aguiar, Alexandra G.
AU - Rendell, Victoria R.
AU - Pokrzywa, Courtney
AU - Rocha, Flavio G.
AU - Kanji, Zaheer S.
AU - Poultsides, George A.
AU - Makris, Eleftherios A.
AU - Dillhoff, Mary E.
AU - Beal, Eliza W.
AU - Fields, Ryan C.
AU - Panni, Roheena Z.
AU - Idrees, Kamran
AU - Smith, Paula Marincola
AU - Cho, Clifford S.
AU - Beems, Megan V.
AU - Maithel, Shishir K.
AU - Winslow, Emily R.
AU - Abbott, Daniel E.
AU - Weber, Sharon M.
N1 - Publisher Copyright:
© 2019, The Society for Surgery of the Alimentary Tract.
PY - 2019/4/15
Y1 - 2019/4/15
N2 - 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.
AB - 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.
KW - Chromogranin A
KW - Pancreatic neuroendocrine tumor
KW - Recurrence
KW - Risk score
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U2 - 10.1007/s11605-018-04080-1
DO - 10.1007/s11605-018-04080-1
M3 - Article
C2 - 30659439
AN - SCOPUS:85060221848
SN - 1091-255X
VL - 23
SP - 651
EP - 658
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 4
ER -