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.
View details for PubMedID 30659439