BACKGROUND Studies supporting surgical management of metastatic pancreatic neuroendocrine tumor (PNET) are limited by selection bias. Chromogranin A (CgA) has been used as a biomarker for PNET and may reflect disease burden or biology. This study aimed to correlate CgA level with overall survival and to use it to match patients selected for different treatment approaches in an analysis of the impact of surgical management. METHODS 1478 patients diagnosed with PNET in the National Cancer Database (2004-2014) were retrospectively identified, and logistic regression analyses were used to evaluate associations between the presence of metastatic disease and CgA level. After matching patients by CgA level and other factors predictive of surgical management, Kaplan-Meier survival analysis was performed. RESULTS Median CgA level was significantly higher in metastatic versus localized PNET(169 ng/mL versus 66 ng/mL, p < 0.001). On multivariate logistic regression, CgA level was predictive of metastatic disease(OR 1.002, p < 0.001) and survival in metastatic and non-metastatic patients. After matching for CgA level, surgery was associated with improved overall survival. DISCUSSION CgA level is predictive of the presence of distant metastatic disease and overall survival in PNET. When matched by CgA and other predictors of treatment approach, patients with metastatic PNET undergoing surgery have improved survival.

中文翻译：

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手术对转移性胰腺神经内分泌肿瘤的影响：与嗜铬粒蛋白a水平匹配的当代评价。

背景技术支持转移性胰腺神经内分泌肿瘤（PNET）外科治疗的研究受到选择偏倚的限制。嗜铬粒蛋白A（CgA）已被用作PNET的生物标志物，可能反映疾病负担或生物学特性。这项研究旨在将CgA水平与总体生存率相关联，并使用它来匹配选择用于不同治疗方法的患者，以分析手术管理的影响。方法回顾性分析2004-2014年美国国家癌症数据库中1478例诊断为PNET的患者，并采用logistic回归分析评估转移性疾病与CgA水平之间的相关性。在根据CgA水平和其他可预测手术管理的因素对患者进行匹配后，进行Kaplan-Meier生存分析。结果转移性中位CNET的中位CgA水平明显高于局部PNET（169 ng / mL对66 ng / mL，p <0.001）。在多因素logistic回归分析中，CgA水平可预测转移性和非转移性患者的转移性疾病（OR 1.002，p <0.001）和生存率。在匹配CgA水平后，手术与改善的总生存率相关。讨论CgA水平可预测PNET中是否存在远处转移性疾病和整体生存。当与CgA和其他治疗方法预测指标相匹配时，接受手术治疗的转移性PNET患者的生存期得到了改善。001）和转移和非转移患者的生存率。在匹配CgA水平后，手术与改善的总生存率相关。讨论CgA水平可预测PNET中是否存在远处转移性疾病和整体生存。当与CgA和其他治疗方法预测指标相匹配时，接受手术治疗的转移性PNET患者的生存期得到了改善。001）和转移和非转移患者的生存率。在匹配CgA水平后，手术与改善的总生存率相关。讨论CgA水平可预测PNET中是否存在远处转移性疾病和整体生存。当与CgA和其他治疗方法预测指标相匹配时，接受手术治疗的转移性PNET患者的生存期得到了改善。