ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Biochemical Markers
ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Biochemical Markers
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DOI：
10.1159/000472254
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发表时间：
2017-01-01
影响因子：
4.1
通讯作者：
Ferone, Diego
中科院分区：
文献类型：
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作者：
Oberg, Kjell;Couvelard, Anne;Ferone, Diego
在过去的几十年里，生物标志物一直是神经内分泌肿瘤（NETs）患者诊断和随访的支柱。最初，来自各种亚型的NET的分泌产物被认为是诊断和治疗期间要遵循的生物标志物：小肠（SI）NET的血清素，胰腺NET的胃泌素和胰岛素。然而，很明显，大量的NET是所谓的无功能肿瘤，不分泌引起肿瘤相关症状的物质。因此，有必要开发所谓的“通用肿瘤标志物”。“到目前为止，最重要的是嗜铬粒蛋白A和神经元特异性烯醇化酶（NSE）。嗜铬粒蛋白A是大多数NET的最重要的通用生物标志物，其灵敏度和特异性在60%至90%之间。NSE已成为高级别肿瘤患者的相关生物标志物，特别是肺和胃肠道肿瘤。5-羟色胺及其降解产物尿5-羟吲哚乙酸（U-5-HIAA）仍是诊断和随访SINETs的重要指标。近年来，血浆中的5-HIAA已被高效液相色谱法和荧光检测器分析，并显示出良好的一致性与U-5-HIAA分析。在未来，我们将看到新的测试，包括循环肿瘤细胞，循环DNA和mRNA。最近，NET测试已经开发出分析循环血液中的基因转录本。初步数据表明NET具有高灵敏度和特异性。然而，它的确切作用必须在目前正在进行的前瞻性随机对照试验中得到验证。(C)2017 S. Karger AG，巴塞尔
Biomarkers have been the mainstay in the diagnosis and follow-up of patients with neuroendocrine tumors (NETs) over the last few decades. In the beginning, secretory products from a variety of subtypes of NETs were regarded as biomarkers to follow during diagnosis and treatment: serotonin for small intestinal (SI) NETs, and gastrin and insulin for pancreatic NETs. However, it became evident that a large number of NETs were so-called nonfunctioning tumors without secreting substances that caused hormone-related symptoms. Therefore, it was necessary to develop so-called "general tumor markers." The most important ones so far have been chromogranin A and neuron-specific enolase (NSE). Chromogranin A is the most important general biomarker for most NETs with a sensitivity and specificity somewhere between 60 and 90%. NSE has been a relevant biomarker for patients with high-grade tumors, particularly lung and gastrointestinal tract tumors. Serotonin and the breakdown product urinary 5-hydroxyindoleacetic acid (U-5-HIAA) is still an important marker for diagnosing and follow-up of SI NETs. Recently, 5-HIAA in plasma has been analyzed by highperformance liquid chromatography and fluorometric detection and has shown good agreement with U-5-HIAA anal ysis. In the future, we will see new tests including circulating tumor cells, circulating DNA and mRNA. Recently, a NET test has been developed analyzing gene transcripts in circulating blood. Preliminary data indicate high sensitivity and specificity for NETs. However, its precise role has to be validated in prospective randomized controlled trials which are ongoing right now. (C) 2017 S. Karger AG, Basel