Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA.
Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
J Gastrointest Surg. 2019 Apr;23(4):651-658. doi: 10.1007/s11605-018-04080-1. Epub 2019 Jan 18.
Chromogranin A (CgA) may be prognostic for patients with neuroendocrine tumors; however, the clinical utility of this test is unclear.
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.
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.
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.
嗜铬粒蛋白 A（CgA）可能对神经内分泌肿瘤患者具有预后价值；然而，该检测的临床实用性尚不清楚。
从美国神经内分泌肿瘤研究组数据库的 8 个机构中选择接受胰腺神经内分泌肿瘤（pNET）切除术的患者。采用 Cox 回归分析确定预测无复发生存率（RFS）的术前变量，将 p 值<0.1 的变量纳入风险评分。在整个队列的一个独特亚组中对风险评分进行了检验。
在 287 例患者的整个队列中，中位随访时间为 37 个月，5 年 RFS 为 73%。Cox 回归分析确定了纳入风险评分的四个变量：CgA > 5x ULN（HR 4.3，p = 0.01）、肿瘤分级 2/3（HR 3.7，p = 0.01）、复发性疾病切除（HR 6.2，p < 0.01）和肿瘤大小> 4cm（HR 4.5，p = 0.1）。每个变量赋值 1 分。在 63 例独特验证队列中的风险评分测试中，零分患者的肿瘤复发阴性预测值为 95%。
这种简单的术前风险评分系统在识别低肿瘤复发风险的患者方面具有很高的特异性。该检测可在术前用于辅助决策。
