title: Raised circulating Neurokinin A predicts prognosis in metastatic small bowel neuroendocrine tumours. Lowering Neurokinin A indicates improved prognosis.
abstract: BACKGROUND
  Assessing prognosis is important in patients with neuroendocrine tumours of the small bowel as disease progression and survival is variable. We previously identified raised Neurokinin A as an independent indicator of poor prognosis and have shown that prognosis worsens when circulating Neurokinin A rises ≥50 ng/L. In the present study we have examined survival in relation to Neurokinin A concentrations.
  
  
  METHODS
  Patients in whom Neurokinin A rose ≥50 ng/L between January 1989 and December 2010 were identified. All circulating Neurokinin A concentrations were recorded and survival was followed up to 31 December 2014 or to death.
  
  
  RESULTS
  Median survival, from the date when Neurokinin A was first ≥50 ng/L was 11.1 (2.0-117.8) months if Neurokinin A remained ≥50 ng/L and 72.4 (4.8-152.6) months when Neurokinin A was reduced below 50 ng/L and controlled below that concentration for ≥3 months (P < 0.001). Survival was significantly better for patients attending the neuroendocrine tumour specialist clinic than for those not attending (P = 0.009). Comparing patients identified during 1989-2000, and those during 2001-2010, Neurokinin A was successfully reduced in the earlier period in 30.3% patients with median survival 23.2 (2.0-152.6) months and this improved in 58.1% with median survival of 43.3 (2.0-141.1) months in the later period (P = 0.019). Significance was greater between the earlier and later periods when only patients attending the neuroendocrine tumour clinic were compared (P = 0.016).
  
  
  CONCLUSIONS
  Circulating Neurokinin A ≥ 50 ng/L is a strong indicator of poor prognosis when Neurokinin A remains above this concentration. Lowering Neurokinin A below 50 ng/L indicates a significant improvement in prognosis (P < 0.001). This prognostic indicator reflects improved treatment and survival in more recent years.
authors.affiliation: Neuroendocrine Tumour Group, Royal Victoria Hospital, Belfast, Northern Ireland, UK Joy.ardill@qub.ac.uk.
authors.forename: Joy Es
authors.initials: JE
authors.lastname: Ardill
authors.affiliation: Neuroendocrine Tumour Group, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: David R
authors.initials: DR
authors.lastname: McCance
authors.affiliation: Neuroendocrine Tumour Group, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: Wendy V
authors.initials: WV
authors.lastname: Stronge
authors.affiliation: Neuroendocrine Tumour Group, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Johnston
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood*; D006801:Humans; D007414:Intestinal Neoplasms / Q000097:blood* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D009362:Neoplasm Metastasis; D018358:Neuroendocrine Tumors / Q000097:blood* / Q000473:pathology; D015288:Neurokinin A / Q000097:blood*; D011379:Prognosis; D011863:Radioimmunoassay; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; D015288:Neurokinin A
keywords: Peptide hormones; gastrointestinal disorders; tumour markers