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PTH-093 Chromogranin-a : Can It Predict Radiological Progression In Neuroendocrine Tumours?
  1. RE Rossi1,2,
  2. J Garcia-Hernandez1,
  3. NG Martin3,
  4. M Mullan1,
  5. T Meyer4,
  6. C Thirlwell4,
  7. J Watkins5,
  8. ME Caplin1,
  9. C Toumpanakis1
  1. 1Neuroendocrine Tumour Unit, Centre for Gastroenterology, Royal Free Hospital, London, UK
  2. 2Postgraduate School of Gastroenterology, Universita’degli Studi Di Milano, Milan, Italy
  3. 3Department of Clinical Biochemistry, Royal Free Hospital, London, UK
  4. 4Cancer Institute, University College London, Huntley Street, London, UK
  5. 5Department of Histopathology, Royal Free Hospital, London, UK

Abstract

Introduction Chromogranin A (CgA) is considered as the best general marker for the diagnosis and follow-up of neuroendocrine tumours (NETs) and is also of prognostic value. In literature, there are no available studies which analysed the role of CgA as a predictor of radiological disease progression in all NETs. Present study investigates the prognostic value of CgA as a predictor of radiological disease progression in NET patients.

Methods Patients with metastatic NETs and evidence of Radiological Progression (RP) according to RECIST 1.1 were identified from a NET database. Plasma CgA were measured 6 and 12 months before RP and at the event of RP. CgA was measured with the Supra-regional-Assay-Service radioimmunoassay (Hammersmith Hospital), normal value <60 pmol/L. The tumours were graded according to the 2010 WHO classification, as G1 (Ki67 <2%), G2 (Ki67: 2–20%), G3 (Ki67 >20%).

Results 152 patients were evaluable including 91 midgut NET and 61 pancreatic NETs (PNETs). Of these, 56 were G1 NETs, 65 G2, 10 G3, 21 of unknown histology. 95.4% of the patients had liver metastases, whereas bone and lung metastases were present in a smaller proportion of patients (27.6 and 9.9%, respectively). Median CgA for all NETs 6 months before RP was 213 pmol/L [Interquartile 1 (Q1)=67 and 3 (Q3)=664.5 pmol/L] compared to 166 pmol/L (Q1 52, Q3 535 pmol/L) one year before RP, T = 598.5, p = 0.07. Significant results were found for PNETs [median CgA 6 months before RP: 100 pmol/L (Q1 53, Q3 286.25 pmol/L) and at 12 months: 52 pmol/L (Q1 36.25, Q3 128 pmol/L), T=52, p = 0.048], but not for midgut NETs [median CgA 6 months before RP: 389.5 pmol/L (Q1 131.5, Q3 791.5 pmol/L) and at 12 months: 319 pmol/L (Q1 158, Q3 753 pmol/L), T=191, p = .39]. Both midgut and PNETs CgA values were significantly higher at RP than 12 months before [267 pmol/L (Q1=66, Q3=777) vs. 166 pmol/L (Q1=52, Q3=535), T= 394.5, p = 0.03]. Overall, G1 tumours had median CgA value at 6 months significantly higher than at 12 months [181(Q1=56.25, Q3=624) vs. 149.5 pmol/L (Q1=44, Q3=247.25), T=70, p = 0.048].

Conclusion CgA seems to have predictive value 6 months prior to RP for PNETs and G1 tumours, which may be of value to identify specific subgroups of patients who may benefit from a more aggressive follow-up with possible early intervention in case of increased CgA levels. Further prospective studies are needed to enable more definitive conclusions.

References 1 Oberg K et al. Pancreas 2011

2 Ter-Minassian M et al. Endocr Relat Cancer 2013

3 Welin S et al. Neuroendocrinology 2009

4 Jensen KH et al. Scand J Gastroenterol 2013

Disclosure of Interest None Declared.

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