A rapid rise in circulating pancreastatin in response to somatostatin analogue therapy is associated with poor survival in patients with neuroendocrine tumours

This version was published on 1 November 2008

Ann Clin Biochem 2008;45:560-566
© 2008 Association for Clinical Biochemistry


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Original Articles

R L Stronge1,
G B Turner2,
B T Johnston3,
D R McCance3,
A McGinty4,
C C Patterson5 and
J E S Ardill3

1 St George’s Hospital Medical School, University of London;
2 Altnagelvin Hospital, Londonderry;
3 Neuroendocrine Tumour Group, Royal Victoria Hospital;
4 School of Medicine;
5 Medical Statistics, Queen’s University, Belfast, UK

Corresponding author: Professor Joy Ardill. Email: joyardill{at}belfasttrust.hscni.net

Aim: To assess the value of pancreastatin as a predictive factorfor identifying patients with neuroendocrine tumours (NETs)who respond poorly to somatostatin analogues.

Methods: A retrospective study of patients with NETs. Patient recordsfrom the Northern Ireland Neuroendocrine Tumour Register wereinterrogated. Those who had pancreastatin concentrations measuredon two or more occasions, before and during somatostatin analoguetherapy (within the set time-limits) were selected. Data relatingto diagnosis, surgery, somatostatin analogue therapy and survivaloutcome were noted. Data were subjected to univariate and multivariateanalysis using Cox proportional hazard model.

Results: Fifty-nine patients with gastroenteropancreatic NETs fulfilled the inclusion criteria. Factors associated with a poor survival outcome on univariate analysis were primary tumour site (P = 0.006) and rapid rise in pancreastatin during somatostatin analogue treatment (P < 0.001). In multivariate analysis, highly significant clinical prognostic indicators were: tumour location (P < 0.001), pre-treatment pancreastatin (P < 0.001) and pancreastatin change (P < 0.001).

Conclusions: This study endorses the finding that pancreastatin is a usefulprognostic indicator of neuroendocrine disease. On commencementof treatment, one-third of the subjects showed an immediatenegative pancreastatin response to somatostatin analogues, whichwas associated with poor survival. This is the first study todocument such an association. These findings have significanttherapeutic consequences. In the presence of a rapidly risingpancreastatin alternative, treatment modalities should be sought.

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