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2014 ; 21
(9
): 2971-80
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Pancreastatin predicts survival in neuroendocrine tumors
#MMPMID24752611
Sherman SK
; Maxwell JE
; O'Dorisio MS
; O'Dorisio TM
; Howe JR
Ann Surg Oncol
2014[Sep]; 21
(9
): 2971-80
PMID24752611
show ga
BACKGROUND: Serum neurokinin A, chromogranin A, serotonin, and pancreastatin
reflect tumor burden in neuroendocrine tumors. We sought to determine whether
their levels correlate with survival in surgically managed small bowel (SBNETs)
and pancreatic neuroendocrine tumors (PNETs). METHODS: Clinical data were
collected with Institutional Review Board approval for patients undergoing
surgery at one center. Progression-free (PFS) and overall (OS) survival were from
the time of surgery. Event times were estimated by the Kaplan-Meier method.
Preoperative and postoperative laboratory values were tested for correlation with
outcomes. A multivariate Cox model adjusted for confounders. RESULTS: Included
were 98 SBNETs and 78 PNETs. Median follow-up was 3.8 years; 62 % had metastatic
disease. SBNETs had lower median PFS than PNETs (2.0 vs. 5.6 years; p < 0.01).
Median OS was 10.5 years for PNETs and was not reached for SBNETs. Preoperative
neurokinin A did not correlate with PFS or OS. Preoperative serotonin correlated
with PFS but not OS. Higher levels of preoperative chromogranin A and
pancreastatin showed significant correlation with worse PFS and OS (p < 0.05).
After multivariate adjustment for confounders, preoperative and postoperative
pancreastatin remained independently predictive of worse PFS and OS (p < 0.05).
Whether pancreastatin normalized postoperatively further discriminated outcomes.
Median PFS was 1.7 years in patients with elevated preoperative pancreastatin
versus 6.5 years in patients with normal levels (p < 0.001). CONCLUSIONS: Higher
pancreastatin levels are significantly associated with worse PFS and OS in SBNETs
and PNETs. This effect is independent of age, primary tumor site, and presence of
nodal or metastatic disease. Pancreastatin provides valuable prognostic
information and identifies surgical patients at high risk of recurrence who could
benefit most from novel therapies.
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