Rossi Roberta Elisa, Ciafardini Clorinda, Sciola Valentina, Conte Dario, Massironi Sara
From the Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Department of Pathofisiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Pancreas. 2018 Nov/Dec;47(10):1249-1255. doi: 10.1097/MPA.0000000000001184.
Little is known about chromogranin A (CgA) during follow-up of gastroenteropancreatic neuroendocrine neoplasms. We hypothesized that serial CgA monitoring might be useful for the assessment of tumor progression, and we performed a systematic review of the literature and meta-analysis.
A bibliographical search was performed in PubMed using "chromogranin A" and "neuroendocrine tumors" and "follow-up" and "biomarker" to identify all pertinent articles published in the last 10 years.
Eight studies were included in current meta-analysis. Chromogranin A as a follow-up marker shows sensitivity between 46% and 100% and specificity between 68% and 90%. The meta-analysis results showed an overall accuracy of 84% (95% confidence interval [CI], 81-86.6), a cumulative sensitivity of 74.6% (95% CI, 61.9-85.4), and a cumulative specificity of 84.7% (95% CI, 81.3-87.7). These data indicate that circulating CgA has a better overall accuracy in the follow-up setting; it can be used to rule the diagnosis of recurrence/progression in, rather than to rule it out.
Chromogranin A is more reliable when used to monitor disease progression and response to treatment and for the early detection of recurrence after treatment rather than in the diagnostic setting. It is more sensible to use this marker in those cases where the initial values were impaired.
关于胃肠胰神经内分泌肿瘤随访期间嗜铬粒蛋白A（CgA）的情况，我们了解得很少。我们推测连续监测CgA可能有助于评估肿瘤进展，因此我们对文献进行了系统回顾和荟萃分析。
在PubMed中使用“嗜铬粒蛋白A”、“神经内分泌肿瘤”、“随访”和“生物标志物”进行文献检索，以识别过去10年发表的所有相关文章。
本次荟萃分析纳入了8项研究。嗜铬粒蛋白A作为随访标志物的敏感性在46%至100%之间，特异性在68%至90%之间。荟萃分析结果显示总体准确率为84%（95%置信区间[CI]，81 - 86.6），累积敏感性为74.6%（95%CI，61.9 - 85.4），累积特异性为84.7%（95%CI，81.3 - 87.7）。这些数据表明，循环CgA在随访中总体准确率更高；它可用于诊断复发/进展，而非排除复发/进展。
嗜铬粒蛋白A用于监测疾病进展、治疗反应以及治疗后复发的早期检测时比用于诊断更可靠。在初始值受损的情况下使用该标志物更合理。
