Circulating Neuroendocrine Gene Transcripts (NETest): A Postoperative Strategy for Early Identification of the Efficacy
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ORIGINAL ARTICLE – PANCREATIC TUMORS
Circulating Neuroendocrine Gene Transcripts (NETest): A Postoperative Strategy for Early Identification of the Efficacy of Radical Surgery for Pancreatic Neuroendocrine Tumors Stefano Partelli, MD, PhD1, Valentina Andreasi, MD1, Francesca Muffatti, MD1, Marco Schiavo Lena, MD2, and Massimo Falconi, MD1 1
Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Hospital Neuroendocrine Tumor Group (ENETS Center of Excellence), IRCCS San Raffaele Scientific Institute, ‘‘Vita-Salute San Raffaele’’ University, Milan, Italy; 2Department of Pathology, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, ‘‘Vita-Salute San Raffaele’’ University, Milan, Italy
ABSTRACT Background. Surgery remains the only treatment for the cure of pancreatic neuroendocrine tumors (PanNETs). Biomarkers to identify the completeness of resection and predict recurrence are lacking. Objective. The aims of this study were to evaluate if the blood measurement of neuroendocrine gene transcripts (NETest) was diagnostic of PanNETs, and whether NETest blood levels could identify complete resection. We compared transcript analysis with the biomarker chromogranin A (CgA). Methods. This was a prospective, longitudinal, singlecenter study including 30 patients with a postoperative histological confirmation of PanNET. Blood for NETest and CgA was collected preoperatively and on postoperative day (POD) 1, POD5, and POD30. Transcripts were measured by real-time quantitative reverse transcription polymerase chain reaction and multianalyte algorithmic analysis (NETest; normal \ 20), and CgA was measured by enzyme-linked immunosorbent assay (ELISA; normal \ 109 ng/mL). Data are expressed as mean ± standard deviation (SD).
Stefano Partelli and Valentina Andreasi share first authorship. Ó Society of Surgical Oncology 2020 First Received: 24 July 2019 M. Falconi, MD e-mail: [email protected]
Results. Pancreatic surgical resections (n = 30) were R0, 26; R1, 2; and R2, 2. Preoperatively, NETest score was elevated in all 30 patients (44.7 ± 27), but postoperatively, NETest scores significantly decreased (p = 0.006) to POD30 (24.7 ± 24). The proportion of patients (15/30) with an elevated score significantly decreased by POD30 (p \ 0.0001). CgA levels were elevated preoperatively (184 ± 360 ng/mL) in only 9/30 patients, but did not decrease significantly postoperatively at POD30 (260 ± 589 ng/mL, p = 0.398). The number of patients with elevated CgA levels remained unchanged (9/30). Conclusions. The NETest is an accurate diagnostic biomarker for PanNETs (100%). A decrease in NETest levels after radical resection suggests this blood test provides early assessment of surgical efficacy. CgA had no clinical utility.
Multiple treatment approaches are currently available for patients with pancreatic neuroendocrine tumors (PanNETs), but surgery is still considered the only treatment associated with cure.1–3 A key issue however is the need for strategies to define
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