title: Comparison of the utility of Cocaine- and Amphetamine-Regulated Transcript (CART), chromogranin A, and chromogranin B in neuroendocrine tumor diagnosis and assessment of disease progression.
abstract: BACKGROUND
  Prognosis in patients with neuroendocrine tumors (NETs) is often poor, frequently reflecting delayed diagnosis. Hence, accurate and practical NET markers are needed. Cocaine- and amphetamine-regulated transcript (CART) peptide is a potential novel NET marker.
  
  
  METHODS
  Circulating levels of CART peptide and the established NET markers chromogranin A (CgA) and chromogranin B (CgB) were measured using RIA in 353 patients with NET (normal renal function) and in controls. Clinical data were collected retrospectively.
  
  
  METHODS
  The comparative and combined utility of CART, CgA, and CgB for diagnosis and assessment of disease progression was measured in different NET subtypes.
  
  
  RESULTS
  CgA and CgB in combination improved diagnostic accuracy in patients with gut NETs, nongastroenteropancreatic NETs, and NETs with an unknown primary origin compared with each biomarker alone. Measuring CART did not further improve diagnosis in these NET subtypes. For pancreatic NETs, CgB was superior to CgA and CART in detecting stable disease (P < .007), whereas CgA and CART in combination were most effective in identifying progressive disease. In phaeochromocytomas/paragangliomas (PCC/PGL), CART was the most useful biomarker for identifying stable (P < .001) and progressive (P = .001) disease. Consistent with this, plasma CART decreased following PCC/PGL tumor resection, remaining low in all patients in remission, but increasing in those with progressive disease.
  
  
  CONCLUSIONS
  CART is a useful marker for identifying progressive pancreatic NETs. CART is superior to CgA and CgB in detecting stable and progressive PCC/PGLs, and may have a role as a surveillance marker for PCC/PGL patients.
authors: European Neuroendocrine Tumor Society (ENETS) Centre of Excellence (R.R., P.B., K.G.M., M.P., S.V., W.S.D., R.S., F.F.P., Z.W., T.T., K.M., A.F., M.A.G., S.R.B., N.M.M.), Division of Diabetes, Endocrinology and Metabolism, Section of Investigative Medicine (R.R., P.B., K.G.M., M.P., S.V., W.S.D., T.T., K.M., M.A.G., S.R.B., N.M.M.), Imperial College London, London, W12 0HS United Kingdom; ENETS Centre of Excellence Neuroendocrine Tumor Unit (M.E.C., M.S.K., B.K.), Royal Free London NHS Foundation Trust Hospital, London, NW3 2QG. United Kingdom; Department of Gastroenterology (M.S.K.), University Hospital of Wales, Cardiff, CF14 4XW United Kingdom; Division of Experimental Medicine (R.S.), Departments of Surgery and Cancer (F.F.P.), and Radiology (Z.W.), Imperial College Healthcare NHS Trust, London, London W12 0HS, United Kingdom.
authors: R
authors: R
authors: Ramachandran
authors: P
authors: P
authors: Bech
authors: K G
authors: KG
authors: Murphy
authors: M E
authors: ME
authors: Caplin
authors: M
authors: M
authors: Patel
authors: S
authors: S
authors: Vohra
authors: M S
authors: MS
authors: Khan
authors: W S
authors: WS
authors: Dhillo
authors: R
authors: R
authors: Sharma
authors: F F
authors: FF
authors: Palazzo
authors: Z
authors: Z
authors: Win
authors: T
authors: T
authors: Tan
authors: B
authors: B
authors: Khoo
authors: K
authors: K
authors: Meeran
authors: A
authors: A
authors: Frilling
authors: M A
authors: MA
authors: Ghatei
authors: S R
authors: SR
authors: Bloom
authors: N M
authors: NM
authors: Martin
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000097:blood / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D016022:Case-Control Studies; D053379:Chromogranin A / Q000097:blood*; D053378:Chromogranin B / Q000097:blood*; D003940:Diagnostic Techniques, Endocrine; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009419:Nerve Tissue Proteins / Q000097:blood*; D018358:Neuroendocrine Tumors / Q000097:blood / Q000175:diagnosis*; D010235:Paraganglioma / Q000097:blood / Q000175:diagnosis*; D010673:Pheochromocytoma / Q000097:blood / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult; D000098882:Cocaine- and Amphetamine-Regulated Transcript Protein
chemical_list: D014408:Biomarkers, Tumor; D053379:Chromogranin A; D053378:Chromogranin B; D009419:Nerve Tissue Proteins; D000098882:Cocaine- and Amphetamine-Regulated Transcript Protein