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

  • Alexander V. Fisher
  • Alexandra G. Lopez-Aguiar
  • Victoria R. Rendell
  • Courtney Pokrzywa
  • Flavio G. Rocha
  • Zaheer S. Kanji
  • George A. Poultsides
  • Eleftherios A. Makris
  • Mary E. Dillhoff
  • Eliza W. Beal
  • Ryan C. Fields
  • Roheena Z. Panni
  • Kamran Idrees
  • Paula Marincola Smith
  • Clifford S. Cho
  • Megan V. Beems
  • Shishir K. Maithel
  • Emily R. Winslow
  • Daniel E. Abbott
  • Sharon M. WeberEmail author
2018 SSAT Plenary Presentation
  • 76 Downloads

Abstract

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.

Keywords

Chromogranin A Pancreatic neuroendocrine tumor Recurrence Risk score 

Notes

Acknowledgements

SMW and DEA are supported with the resources and use of facilities at the William S. Middleton Memorial Veterans Hospital, Madison, WI.

Funding Information

AVF’s position as a research fellow is supported by NIH Surgical Oncology Training Grant (T32 CA090217), and an American College of Surgeons Resident Research Scholarship.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Supplementary material

11605_2018_4080_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)

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Copyright information

© The Society for Surgery of the Alimentary Tract 2019

Authors and Affiliations

  • Alexander V. Fisher
    • 1
  • Alexandra G. Lopez-Aguiar
    • 2
  • Victoria R. Rendell
    • 1
  • Courtney Pokrzywa
    • 1
  • Flavio G. Rocha
    • 3
  • Zaheer S. Kanji
    • 3
  • George A. Poultsides
    • 4
  • Eleftherios A. Makris
    • 4
  • Mary E. Dillhoff
    • 5
  • Eliza W. Beal
    • 5
  • Ryan C. Fields
    • 6
  • Roheena Z. Panni
    • 6
  • Kamran Idrees
    • 7
  • Paula Marincola Smith
    • 7
  • Clifford S. Cho
    • 8
  • Megan V. Beems
    • 8
  • Shishir K. Maithel
    • 2
  • Emily R. Winslow
    • 1
  • Daniel E. Abbott
    • 1
  • Sharon M. Weber
    • 1
    Email author
  1. 1.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  2. 2.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  3. 3.Department of SurgeryVirginia Mason Medical CenterSeattleUSA
  4. 4.Department of SurgeryStanford University Medical CenterStanfordUSA
  5. 5.Division of Surgical OncologyThe Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusUSA
  6. 6.Department of SurgeryWashington University School of MedicineSt LouisUSA
  7. 7.Division of Surgical Oncology, Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  8. 8.Division of Hepatopancreatobiliary and Advanced Gastrointestinal Surgery, Department of SurgeryUniversity of MichiganAnn ArborUSA

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