Plasma chromogranin A as marker for survival in patients with metastatic endocrine gastroenteropancreatic tumors.
OBJECTIVE
The prognostic role of plasma chromogranin A in patients with neuroendocrine tumors is unclear. We investigated the role of chromogranin A in predicting survival and hypothesized that chromogranin A mirrors tumor burden and that a rapid increase after a phase of stable plasma chromogranin A levels might predict exploding tumor growth.


METHODS
Three hundred forty-four patients with metastatic, well-differentiated neuroendocrine tumors were included. A subsample of 102 patients was investigated to correlate radiologically classified tumor burden with plasma chromogranin A. Hepatic tumor burden (0%, 0%-25%, 25%-50%, >50%) was assessed from computed tomography/magnetic resonance imaging scans. Follow-up information until death was generated in regular intervals.


RESULTS
Plasma chromogranin A levels (U/L) vary between tumor entities (Kruskal-Wallis, P < .001) and were associated with survival time (hazard ratio [hours], 2.14 per one unit in the log10 CgA level scale; 95% confidence interval [CI], 1.75-2.62; P < .001). Chromogranin A levels correlated with hepatic tumor burden (Spearman P = .57; 95% CI, 0.44-0.70; P < .001). Additional extrahepatic tumor load did not relevantly affect plasma chromogranin A. A sudden increase observed in individual patients was paralleled by rapid tumor progress and short survival.


CONCLUSIONS
Increased plasma chromogranin A in patients with metastatic neuroendocrine tumors is predictive for shorter survival. There was a modest correlation between chromogranin A levels and hepatic tumor burden. We hypothesized further that a sudden increase in individual chromogranin A levels indicates unfavorable outcome.
Department of Internal Medicine, Division of Gastroenterology and Endocrinology, Philipps University, Marburg, Germany. arnoldr@mailer.unimarburg.de
Rudolf
R
Arnold
Alexandra
A
Wilke
Anja
A
Rinke
Christina
C
Mayer
Peter Herbert
PH
Kann
Klaus-Jochen
KJ
Klose
André
A
Scherag
Maik
M
Hahmann
Hans-Helge
HH
Müller
Peter
P
Barth
D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D053379:Chromogranin A / Q000097:blood*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000556:secondary*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000175:diagnosis* / Q000556:secondary*; D011379:Prognosis; D013223:Statistics as Topic; D013534:Survival; D015996:Survival Rate
D014408:Biomarkers, Tumor; D053379:Chromogranin A