Details

Autor(en) / Beteiligte

• Modlin, Irvin M., MD, PhD, DSc
• Frilling, Andrea, MD, PhD
• Salem, Ronald R., MD
• Alaimo, Daniele, MS
• Drymousis, Panagiotis, MD, PhD
• Wasan, Harpreet S., MD, FRCP
• Callahan, Stephen, MS
• Faiz, Omar, MBBS, FRCS, MS
• Weng, Lei, MBBS
• Teixeira, Nancy, MSN
• Bodei, Lisa, MD, PhD
• Drozdov, Ignat, PhD
• Kidd, Mark, PhD

Titel

Blood measurement of neuroendocrine gene transcripts defines the effectiveness of operative resection and ablation strategies

Ist Teil von

• Surgery, 2016, Vol.159 (1), p.336-347

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2016

Quelle

MEDLINE

Beschreibungen/Notizen

• Background Surgery is the only curative treatment for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), but the prediction of residual disease/recurrence is limited in the absence of optimal biomarkers. We examined whether a blood-based multianalyte neuroendocrine gene transcript assay (NETest) would define tumor cytoreduction and therapeutic efficacy. Methods The NETest is a polymerase chain reaction–based analysis of 51 genes. Disease activity is scaled 0–100%; minimal <14%, low 14–47%, and high >47%. A total of 35 GEP-NETs in 2 groups were evaluated. I: after surgery (R0, n  = 15; residual, n  = 12); II: nonsurgery ( n  = 8: embolization with gel-foam alone [bland: n  = 3]), transarterial chemoembolization ( n  = 2), and radiofrequency embolization ( n  = 3). Measurement (quantitative real-time-polymerase chain reaction) and chromogranin A (CgA; enzyme-linked immunosorbent assay) were undertaken preoperatively and 1 month after treatment. Results NETest score was increased in 35 (100%) preoperatively; 14 (40%) had increased CgA (χ2  = 30, P  < 2 × 10−8 ). Resection reduced NETest from 80 ± 5% to 29% ± 5, ( P  < .0001). CgA decrease was insignificant (14.3 ± 1.6U/L to 12.2 ± 1.7U/L). NETest decreases correlated with diminished tumor volume (R2  = 0.29, P  = .03). Cytoreduction significantly reduced NETest from 82 ± 3% to 41% ± 6, P  < .0001). CgA was not decreased (21.4 ± 5.5U/L to 18.4 ± 10.1U/L). Four (36%) of 11 R0s with increased NETest at 1 month developed positive imaging (sensitivity 100%, specificity 20%). One hundred percent (ablated group) were transcript- and image-positive. Conclusion Blood NET transcripts delineate surgical resection/cytoreduction and facilitate identification of residual disease.