Serum chromogranin A is a useful marker for Japanese patients with pancreatic neuroendocrine tumors

Abstract

Although chromogranin A (CGA) is a useful marker for pancreatic neuroendocrine tumors (pNET) in the West, its usefulness in Japanese populations is unclear. To assess this, we evaluated the serum CGA levels in 189 patients with various pancreatic diseases, including proven pNET (n = 69), pancreatic cancer (PC) (n = 50), chronic pancreatitis (CP) (n = 50) and autoimmune pancreatitis (AIP) (n = 20), and 112 normal controls (controls) using an ELISA kit. The mean CGA level of patients with pNET was significantly higher than any of the other groups (407.8 ± 984.6 ng/mL [pNET] vs 91.8 ± 101.8 ng/mL [PC], 93.6 ± 57.5 ng/mL [CP], 69.9 ± 52.4 ng/mL [AIP] and 62.5 ± 48.3 ng/mL [controls]). Limiting the analysis to patients not using proton pump inhibitors (PPI), the CGA level of patients with PC or CP was not significantly different compared with the controls. Discriminant analysis revealed that the best cut-off value of CGA to distinguish patients with pNET from the controls was 78.7 ng/mL, with a sensitivity and specificity of 53.6% and 78.6%, respectively. In patients with pNET, significant factors associating with elevated CGA levels were tumor classification, tumor size, and the presence of liver metastases in univariate analysis as well as PPI use and the presence of liver metastases in multivariate analysis. We show that CGA is a useful marker for diagnosing pNET in Japanese populations and for distinguishing patients with pNET from patients with other pancreatic diseases. The increased use of CGA in Japan will likely be a helpful tool in managing these patients, as found in the West.

Keywords: Chromogranin A; Japan; pancreatic cancer; pancreatic neuroendocrine tumors; proton pump inhibitors.

Fig 1

Distribution of serum chromogranin A level in this study.

Fig 2

(a) Result of discriminant function calculated in this study. (b) Receiver operating characteristic curve of chromogranin A for patients with pancreatic neuroendocrine tumors versus normal.

Fig 3

(a) Correlation coefficient between serum chromogranin A levels and tumor markers in patients with pancreatic neuroendocrine tumors. Scatter plots for relationship (b) between serum chromogranin A and neuron specific enolase (c) between serum chromogranin A and gastrin.