Predictive Value of Chromogranin A and a Pre-Operative Risk Score to Predict Recurrence After Resection of Pancreatic Neuroendocrine Tumors. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Fisher, A. V., Lopez-Aguiar, A. G., Rendell, V. R., Pokrzywa, C., Rocha, F. G., Kanji, Z. S., Poultsides, G. A., Makris, E. A., Dillhoff, M. E., Beal, E. W., Fields, R. C., Panni, R. Z., Idrees, K., Smith, P. M., Cho, C. S., Beems, M. V., Maithel, S. K., Winslow, E. R., Abbott, D. E., Weber, S. M. 2019


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 37months, 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 >4cm (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.

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