title: Elevated plasma chromogranin A is the first indication of recurrence in radically operated midgut carcinoid tumors.
abstract: BACKGROUND
  Patients with malignant midgut carcinoids are occasionally diagnosed with limited tumor spread, and surgery with radical intention is performed. Despite curative intent, recurrences occur frequently, motivating long-term biochemical and radiological follow-up. This study aimed to compare the usefulness of various methods in detecting such recurrences.
  
  
  METHODS
  This retrospective study included 56 patients with radically operated midgut carcinoids referred to our University Hospital for evaluation and follow-up between 1985 and 2004. Patients were monitored 1-3 times per year using plasma-chromogranin A (P-CgA), urinary 5-hydroxyindoleacetic acid (U-5HIAA) concentrations as well as radiological examinations, including ultrasonography, computerized tomography or magnetic resonance investigation. In a subset of cases, somatostatin receptor scintigraphy and/or positron emission tomography with 5-hydroxytryptophan was performed. Time from operation until established recurrence was recorded.
  
  
  RESULTS
  Tumor recurrence was established in 33 of 56 patients after a median of 32 months (range 6-217). Elevated P-CgA was the first marker to become pathologically elevated in 28 of these 33 patients (85%). In 3 of these 28 patients, radiology was simultaneously positive for a recurrence.
  
  
  CONCLUSIONS
  P-CgA was the first marker to indicate tumor recurrence in the majority of radically operated midgut carcinoid patients. To avoid unnecessary and costly examinations in asymptomatic patients, we suggest that follow-up should comprise measurements of P-CgA twice a year and annual ultrasonography until P-CgA is elevated or clinical symptoms occur, at which time all efforts should be made to identify recurrent tumor lesions in order to give the patient the best possible treatment which, if possible, should be surgical removal of the recurrence.
authors.affiliation: Department of Medical Sciences, Unit of Endocrine Oncology, University Hospital, Uppsala, Sweden. staffan.welin@medsci.uu.se
authors.forename: Staffan
authors.initials: S
authors.lastname: Welin
authors.forename: Mats
authors.initials: M
authors.lastname: Stridsberg
authors.forename: Janet
authors.initials: J
authors.lastname: Cunningham
authors.forename: Dan
authors.initials: D
authors.lastname: Granberg
authors.forename: Britt
authors.initials: B
authors.lastname: Skogseid
authors.forename: Kjell
authors.initials: K
authors.lastname: Oberg
authors.forename: Barbro
authors.initials: B
authors.lastname: Eriksson
authors.forename: Eva T
authors.initials: ET
authors.lastname: Janson
mesh_terms: D006916:5-Hydroxytryptophan / Q000652:urine; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D002276:Carcinoid Tumor / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D053379:Chromogranin A / Q000097:blood*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D017481:Receptors, Somatostatin / Q000032:analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D014408:Biomarkers, Tumor; D053379:Chromogranin A; D017481:Receptors, Somatostatin; D006916:5-Hydroxytryptophan