Plasma Chromogranin A Response to Octreotide Test: Prognostic Value for Clinical Outcome in Endocrine Digestive Tumors
Plasma Chromogranin A Response to Octreotide Test: Prognostic Value for Clinical Outcome in Endocrine Digestive Tumors
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DOI：
10.1038/ajg.2010.154
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发表时间：
2010-09-01
影响因子：
9.8
通讯作者：
Peracchi, Maddalena
中科院分区：
文献类型：
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作者：
Massironi, Sara;Conte, Dario;Peracchi, Maddalena
目的：表达生长抑素受体的胃肠胰腺神经内分泌肿瘤可用生长抑素类似物(SSAs)治疗。选择标准是奥曲肽阳性或奥曲肽皮下注射后激素水平下降50%。注射(奥曲肽试验)(OT)。血浆嗜铬粒蛋白A(CgA)是最好的通用GEP-Net标记物，但有关CgA对OT反应的资料较少。方法：38例GEP-Net患者在确诊时接受奥曲肽200mg.sc，于0、3和6h测定血浆CgA水平。通过监测症状、生化和客观反应，长期给予SSA治疗，并观察存活率。结果：有功能肿瘤患者的基础血浆CgA水平显著高于无功能肿瘤患者(中位数(范围)：220(18-2230)vs.46(25-8,610)U/L)，有转移者(171(18-8,610)U/L比43(28-220)U/L，P=0.04)。CgA水平与WHO分级、临床TNM分期、Ki-67增殖指数显著相关。OT治疗后，CgA水平从14 6(18~8,610)降至61(10~8,535)U/L(基础值和最低值)，P<；0.001。在对OT有反应的患者中，21/31例患者客观反应成功(68%)。症状缓解成功13例(72%)，生化反应25例(81%)，客观反应21例(68%)。在其余7例CGA下降30%的无反应病例中，有6例(86%)病情进展至死亡。有反应的患者的中位生存期为48个月(6-138年)，无反应的患者为6(6-30)个月(P=0.0005)。结论：在GEP-Net患者中，血浆CgA是一个可靠的标记物，而在OT后下降30%具有相关的预后意义，可以识别最有可能对慢性SSA有反应的患者亚群。
OBJECTIVES: Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) expressing somatostatin receptors may be treated with somatostatin analogs (SSAs). Selection criteria are a positive Octreoscan or a > 50% hormone level decrease after octreotide subcutaneous (s.c.) injection (octreotide test) (OT). Plasma chromogranin A (CgA) is the best general GEP-NET marker, but data on CgA response to OT are scanty. Thus, we evaluated whether plasma CgA response to OT could predict the clinical response to SSAs.METHODS: At diagnosis, 38 GEP-NET patients received octreotide 200 mu g s.c., with plasma CgA determination at 0, 3, and 6 h. Long-term SSA treatment was then given by monitoring symptomatic, biochemical, and objective responses, and survival.RESULTS: Basal plasma CgA levels were significantly higher in patients with functioning than non-functioning tumors (median (range): 220 (18-2,230) vs. 46 (25-8,610) U/l, P = 0.03) and in those with than without metastases (171 (18-8,610) vs. 43 (28-220) U/l, P = 0.04). CgA levels significantly correlated with WHO classification, clinical TNM staging, and Ki-67 proliferative index. After OT, CgA levels decreased from 146 (18-8,610) to 61 (10-8,535) U/l (basal and nadir values), P < 0.001. In patients responsive to OT, a successful objective response occurred in 21/31 patients (68%). Successful symptomatic response occurred in 13/18 patients (72%), biochemical response in 25/31 (81%), and objective response in 21/31 (68%). In the remaining seven unresponsive cases, with CgA decrement < 30%, disease progressed to death in six (86%). Median survival from enrollment was 48 months (6-138) in responsive and 6 (6-30) in unresponsive patients (P = 0.0005).CONCLUSIONS: In GEP-NETs, plasma CgA is a reliable marker, and a > 30% decrease after OT has a relevant prognostic meaning allowing the identification of the subgroup of patients most likely to be responsive to chronic SSAs.