Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
HPB (Oxford). 2020 Jan;22(1):83-90. doi: 10.1016/j.hpb.2019.05.011. Epub 2019 Jun 22.
Studies supporting surgical management of metastatic pancreatic neuroendocrine tumor (PNET) are limited by selection bias. Chromogranin A (CgA) has been used as a biomarker for PNET and may reflect disease burden or biology. This study aimed to correlate CgA level with overall survival and to use it to match patients selected for different treatment approaches in an analysis of the impact of surgical management.
1478 patients diagnosed with PNET in the National Cancer Database (2004-2014) were retrospectively identified, and logistic regression analyses were used to evaluate associations between the presence of metastatic disease and CgA level. After matching patients by CgA level and other factors predictive of surgical management, Kaplan-Meier survival analysis was performed.
Median CgA level was significantly higher in metastatic versus localized PNET(169 ng/mL versus 66 ng/mL, p < 0.001). On multivariate logistic regression, CgA level was predictive of metastatic disease(OR 1.002, p < 0.001) and survival in metastatic and non-metastatic patients. After matching for CgA level, surgery was associated with improved overall survival.
CgA level is predictive of the presence of distant metastatic disease and overall survival in PNET. When matched by CgA and other predictors of treatment approach, patients with metastatic PNET undergoing surgery have improved survival.
支持转移性胰腺神经内分泌瘤（PNET）手术治疗的研究受到选择偏倚的限制。嗜铬粒蛋白 A（CgA）已被用作 PNET 的生物标志物，它可能反映疾病负担或生物学特性。本研究旨在分析手术治疗的影响，以评估 CgA 水平与总生存率的相关性，并将其用于匹配不同治疗方法的患者。
回顾性地从国家癌症数据库（2004-2014 年）中确定了 1478 名诊断为 PNET 的患者，并使用逻辑回归分析评估了存在转移性疾病与 CgA 水平之间的关联。通过 CgA 水平和其他预测手术治疗的因素对患者进行匹配后，进行 Kaplan-Meier 生存分析。
转移性 PNET 与局限性 PNET 的中位 CgA 水平显著更高（169ng/mL 比 66ng/mL，p<0.001）。在多变量逻辑回归中，CgA 水平是转移性疾病（OR 1.002，p<0.001）和转移性和非转移性患者的总生存率的预测因素。在按 CgA 水平匹配后，手术与总生存率的提高相关。
CgA 水平可预测 PNET 远处转移疾病和总体生存率。当通过 CgA 和其他治疗方法预测因素匹配时，接受手术治疗的转移性 PNET 患者的生存率得到改善。
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