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Published on: September 8, 2023
Evaluation of circulating transcript analysis (NETest) in small intestinal neuroendocrine neoplasms after surgical
Faidon-Marios Laskaratos1, Man Liu2,3, Anna Malczewska4
1Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, UK. flaskaratos@gmail.com.
Purpose:
Surgical resection is the only effective curative strategy for small intestinal neuroendocrine neoplasms (SINENs). Nevertheless, the evaluation of residual disease and prediction of disease recurrence/progression remains a problematic issue.
Methods:
We evaluated 13 SINENs that underwent surgical resection of the primary tumour and/or mesenteric mass. Patients were divided in three groups: (a) Group 1: SINENs that underwent resection with curative intent, (b) Group 2: SINENs treated with resection in the setting of metastatic disease, which remained stable and (c) Group 3: SINENs treated with resection in the setting of metastatic disease, with evidence of any progression at follow-up. NETest and chromogranin A were measured pre-operatively and post-operatively during a 22-month median follow-up period and compared with imaging studies. NETest score <20% was determined as normal, 20-40% low, 41-79% intermediate and ≥80% high score.
Results:
NETest score was raised in all (100%) SINENs pre-operatively. Surgery with curative intent resulted in NETest score reduction from 78.25 ± 15.32 to 25.25 ± 1.75 (p < 0.05). Low NETest scores post-operatively were evident in all cases without clinical evidence of residual disease (Group 1). However, the low disease activity score suggested the presence of microscopic residual disease. In three cases (75%) with stable disease (Group 2) the NETest score was low consistent with indolent disease. In the progressive disease group (Group 3), a high NETest score was present in three cases (60%) and an intermediate NETest score in the remainder (40%).
Conclusions:
Blood NETest scores accurately identified SINENs and were significantly decreased by curative surgery. Monitoring NETest post-operatively may facilitate management by identifying the presence of residual/progressive disease.
Insights
The NETest blood test accurately identifies small intestinal neuroendocrine neoplasms (SINENs) and decreases after curative surgery. Post-operative monitoring of NETest aids in detecting residual or progressive disease.
Area of Science:
- Oncology
- Gastroenterology
- Biomarker Research
Background:
- Small intestinal neuroendocrine neoplasms (SINENs) are challenging to manage due to difficulties in evaluating residual disease and predicting recurrence.
- Surgical resection is the primary curative treatment for SINENs, but post-operative assessment remains a significant clinical issue.
Purpose of the Study:
- To evaluate the utility of the NETest blood assay in identifying SINENs.
- To assess the effectiveness of NETest in monitoring disease status after surgical resection for SINENs.
- To determine if NETest can aid in the detection of residual or progressive disease.
Main Methods:
- A study involving 13 patients with SINENs who underwent surgical resection.
- Patients were categorized into three groups based on surgical intent and disease status (curative, stable metastatic, progressive metastatic).
- NETest and chromogranin A levels were measured pre- and post-operatively over a median follow-up of 22 months, with results compared to imaging.
Main Results:
- Pre-operative NETest scores were elevated in all (100%) SINENs patients.
- Curative surgery significantly reduced NETest scores (from 78.25 ± 15.32 to 25.25 ± 1.75, p < 0.05).
- Post-operative low NETest scores correlated with no clinical residual disease, while high/intermediate scores indicated progressive disease.
Conclusions:
- Blood NETest scores effectively identified SINENs and decreased significantly following curative surgery.
- Post-operative NETest monitoring shows promise for identifying residual or progressive SINEN disease, aiding clinical management.
