Circulating markers of prognosis and response to treatment in patients with midgut carcinoid tumours

G B Turner ¹, B T Johnston , D R McCance

⁰Regional Peptide Laboratory, Kelvin Building, Royal Victoria Hospital, Grosvenor Rd, Belfast BT12 6BA, UK.

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March 25, 2006

View abstract on PubMed

Summary

Plasma neurokinin A (NKA) is a strong prognostic marker for midgut carcinoid tumors. Rising NKA levels despite treatment indicate poorer survival, while stabilizing or falling levels suggest a survival advantage with somatostatin analogues.

Area Of Science

Oncology
Endocrinology
Tumor Biology

Background

Midgut carcinoid tumors are rare neuroendocrine neoplasms with unpredictable behavior.
Prognostic markers for these tumors are limited.
The survival benefit of somatostatin analogues in treatment remains unproven.

Purpose Of The Study

To identify features associated with poor prognosis in midgut carcinoid tumors.
To evaluate the clinical implications of biochemical response to therapy.
To determine the prognostic value of plasma neurokinin A (NKA).

Main Methods

Retrospective analysis of clinical and biochemical data from 139 midgut carcinoid tumor patients (1978-2000).
Univariate and multivariate survival analyses were performed using death as the endpoint.
Time-dependent covariate analysis assessed the impact of changing biomarker levels during therapy.

Main Results

Plasma NKA, urinary 5-hydroxyindolacetic acid, age, and liver metastases (>5) were associated with poor prognosis on univariate analysis.
Plasma NKA was the sole independent predictor of outcome in multivariate analysis.
Patients with rising NKA levels despite somatostatin analogue treatment had significantly worse survival (40% 1-year survival) compared to those with stabilized or falling levels (87% 1-year survival).

Conclusions

Plasma NKA is an accurate prognostic marker for midgut carcinoid tumors.
This study provides evidence for a survival advantage in patients whose plasma NKA levels respond favorably to somatostatin analogues.

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