Abstract: Objective:To investigate the relationship between the level of serum chromogranin A (CgA) and liver metastases of non functional pancreatic neuroendocrine tumors (pNETs).
Methods:The clinical data of 64 patients with non functional pNETs who were admitted to the Zhongshan Hospital of Fudan University from December 2011 to December 2013 were retrospectively analyzed. Thirty nine patients had complete clinical and follow up data, and 25 patients only have clinical data. The levels of serum CgA were detected in 58 patients before liver metastases, and the levels of serum CgA were detected in 51 patients after liver metastases. Patients were re examined every 3 -6 months after the discharge. The level of serum CgA was increased or decreased by more than 50% of the level of serum CgA before the treatment was defined as increase or decrease of serum CgA, otherwise, stable level of serum CgA. The levels of serum CgA were detected by enzyme linked immunosorbent assay, and the liver metastatic tumor load was assessed by three dimensional reconstruction with the data of computed tomography. The efficacy of treatment was evaluated by response evaluation criteria in solid tumors. Patients were followed up via out patient examination till March 2014. Complete or partial remission was defined as disease remisson, stable condition was defined as stable disease, and disease progression or tumor recurrence was defined as disease progression. The measurement data were presented by (P25, P75). The count data were analyzed using the Fisher exact probability, and the measurement data were analyzed using the Kruskal Wallis test or Mann Whitney test. The correlation was tested by Spearman rank correlation.
Results:The levels of serum CgA of pNETs patients with liver metastases was 94.8 μg/L (67.4μg/L, 181.4 μg/L), which was significantly higher than 59.9 μg/L (39.1 μg/L, 88.5 μg/L) of pNETs patients without liver metastases (Z= -3.96, P<0.05). There was a positive correlation between the tumor load and the level of the serum CgA before liver metastases in 51 non functional pNETs patients (r=0.486, P<0.05). Thirty five patients were followed up for a median time of 10 months. In the 14 patients with disease remission, the ratios of patients with increased and stable level of serum CgA were 11/14 and 3/14, respectively. In the 12 patients with a stable condition, the ratios of patients with decreased, stable and increased level of serum CgA were 4/12, 7/12 and 1/12, respectively. In the 9 patients with disease progression, the ratios of patients with stable and increased levels of serum CgA were 2/9 and 7/9, respectively. There were significant differences in the ratios of patients with decreased and increased levels of CgA among the 3 groups of patients (F=11.02, 18.82, P<0.05), while no significant difference was detected in the ratio of patients with stable level of CgA among the 3 groups of patients (F=5.68, P>0.05). The ratio of patients with decreased level of serum CgA in patients with disease remission was significant higher than patients with disease progression or in a stable condition (P<0.05). The ratio of patients with increased level of serum CgA in patients with disease progression was significantly higher than patients with disease remission or in a stable condition (P<0.05).
Conclusions: Increased level of serum CgA might indicate that the efficacy of treatment is poor for non functional pNETs patients with liver metastases. The tumor load is increased as the increase of the serum CgA level.