Arnold Rudolf, Wilke Alexandra, Rinke Anja, Mayer Christina, Kann Peter Herbert, Klose Klaus-Jochen, Scherag André, Hahmann Maik, Müller Hans-Helge, Barth Peter
Department of Internal Medicine, Division of Gastroenterology and Endocrinology, Philipps University, Marburg, Germany.
Clin Gastroenterol Hepatol. 2008 Jul;6(7):820-7. doi: 10.1016/j.cgh.2008.02.052. Epub 2008 Jun 10.
BACKGROUND & AIMS: The prognostic role of plasma chromogranin A in patients with neuroendocrine tumors is unclear. We investigated the role of chromogranin A in predicting survival and hypothesized that chromogranin A mirrors tumor burden and that a rapid increase after a phase of stable plasma chromogranin A levels might predict exploding tumor growth.
Three hundred forty-four patients with metastatic, well-differentiated neuroendocrine tumors were included. A subsample of 102 patients was investigated to correlate radiologically classified tumor burden with plasma chromogranin A. Hepatic tumor burden (0%, 0%-25%, 25%-50%, >50%) was assessed from computed tomography/magnetic resonance imaging scans. Follow-up information until death was generated in regular intervals.
Plasma chromogranin A levels (U/L) vary between tumor entities (Kruskal-Wallis, P < .001) and were associated with survival time (hazard ratio [hours], 2.14 per one unit in the log10 CgA level scale; 95% confidence interval [CI], 1.75-2.62; P < .001). Chromogranin A levels correlated with hepatic tumor burden (Spearman P = .57; 95% CI, 0.44-0.70; P < .001). Additional extrahepatic tumor load did not relevantly affect plasma chromogranin A. A sudden increase observed in individual patients was paralleled by rapid tumor progress and short survival.
Increased plasma chromogranin A in patients with metastatic neuroendocrine tumors is predictive for shorter survival. There was a modest correlation between chromogranin A levels and hepatic tumor burden. We hypothesized further that a sudden increase in individual chromogranin A levels indicates unfavorable outcome.
血浆嗜铬粒蛋白A在神经内分泌肿瘤患者中的预后作用尚不清楚。我们研究了嗜铬粒蛋白A在预测生存方面的作用，并假设嗜铬粒蛋白A反映肿瘤负荷，且在血浆嗜铬粒蛋白A水平稳定阶段后迅速升高可能预示肿瘤爆发性生长。
纳入344例转移性、高分化神经内分泌肿瘤患者。对102例患者的子样本进行研究，以将放射学分类的肿瘤负荷与血浆嗜铬粒蛋白A相关联。通过计算机断层扫描/磁共振成像扫描评估肝脏肿瘤负荷（0%、0%-25%、25%-50%、>50%）。定期生成直至死亡的随访信息。
血浆嗜铬粒蛋白A水平（U/L）在不同肿瘤类型之间存在差异（Kruskal-Wallis检验，P <.001），并与生存时间相关（风险比[小时]，在log10 CgA水平量表中每单位为2.14；95%置信区间[CI]，1.75-2.62；P <.001）。嗜铬粒蛋白A水平与肝脏肿瘤负荷相关（Spearman相关系数P =.57；95% CI，0.44-0.70；P <.001）。额外的肝外肿瘤负荷对血浆嗜铬粒蛋白A无显著影响。个别患者中观察到的突然升高与肿瘤快速进展和短生存期平行。
转移性神经内分泌肿瘤患者血浆嗜铬粒蛋白A升高预示生存期较短。嗜铬粒蛋白A水平与肝脏肿瘤负荷之间存在适度相关性。我们进一步假设，个体嗜铬粒蛋白A水平的突然升高表明预后不良。
